Cahn_FOREWORD.qxp 2/6/08 5:19 pm Page 8
Foreword
Pedro Cahn, MD
President, International AIDS Society (IAS)
Pedro Cahn, MD, is President of the International AIDS Society (IAS). He is also Chief of the Infectious Diseases Unit at Juan A Fernandez
Hospital and an Assistant Professor in Infectious Diseases at the Buenos Aires University Medical School. In addition, Dr Cahn serves as
Director of the Huésped Foundation, the most prestigious HIV clinical research facility in Argentina, which he co-founded in 1988.He has
served as an external advisor for the World Health Organization (WHO) and the Pan-American Health Organization (PAHO), completing
missions in Zaire, Ethiopia, and Honduras, among others. He is also a member of the National AIDS Advisory Board of the Ministry of Health
in Argentina. Dr Cahn has published more than 80 papers in peer-reviewed journals and is a member of the Editorial Board of several
journals, including the Journal of Infectious Diseases and Actualizaciones en SIDA. He chaired the 1st IAS Conference on HIV Pathogenesis
and Treatment, held in Buenos Aires in 2001.
N
early a year ago, in July 2007, the International AIDS Society (IAS) issued the Sydney Declaration, calling for donors to allocate
10% of their funding dedicated to HIV prevention, treatment, and care programming toward research. The Declaration—
named for the host city of the 4th IAS Conference on Pathogenesis, Treatment, and Prevention (IAS 2007)—called for the integration
and scale-up of research efforts. This research is critical to informing scale-up efforts in the developing world and ensuring that HIV
programs are effectively targeted and integrated with other health services.
At the country level, there is growing recognition that investment in research is needed to expand our knowledge and understanding
of how to scale up HIV programs effectively and equitably in the context of weak health systems. Current debates acknowledge that
we need to gather more evidence on how HIV resources can best be managed to contribute to building country-level health systems;
how to better integrate HIV interventions into primary healthcare systems; and how HIV scale-up is influencing other disease-specific
programs at the country level. We believe that HIV/AIDS programs should allocate a set portion of funding for research and knowledge
generation to improving health system performance at the country level.
HIV research has a strong role to play in building health system capacity in developing countries. A number of lessons learned can
already be applied, but huge gaps remain in identifying best practices that can improve HIV treatment, care, and prevention services
while strengthening overall health systems. Current debates that pit the expansion of HIV-specific programming against the goal of
health systems strengthening are missing the point. The scandal is not that HIV services in poor countries are now seen to be vastly
superior to services for other diseases and primary healthcare; the real scandal is that these other services are so pitifully substandard.
Responding effectively to HIV/AIDS will have dramatic positive impacts on overall health systems in many ways. In many countries
integrated HIV programs have helped to strengthen health services for other areas, including antenatal services, pediatric care,
nutrition, malaria, and tuberculosis.
The IAS continues to promote the basic tenets of the Sydney Declaration. In the context of health systems strengthening, the
Declaration’s call for increased investment in research is a call for better public health systems for all. Although HIV roll-out is still failing
to reach all those in need, about 3 million people are now on antiretroviral (ARV) therapy in developing countries. Millions of lives
saved and large numbers of peri-natal (and possibly also sexually transmitted) HIV infections avoided represent a strong argument for
continuing and strengthening the ARV roll-out program. Another important policy topic for the IAS is the removal of unnecessary
barriers to short-term travel of people living with HIV (PLHIV), who face discriminatory laws when they try to enter some countries—
notably the US, Russia, and China—for short visits. Countries that erect entry barriers for PLHIV justify their policies as necessary to
protect public health and the public purse. Clearly, HIV is not communicable through casual contact, and considerable research has
been carried out to show that there is no public health rationale for restricting liberty of movement or choice of residence on the
grounds of HIV status. The IAS believes that it is a right of people living with HIV to travel freely. Discriminatory laws and policies
continue to fuel national and international stigma. These laws sustain a culture of exclusion, rights violations, and marginalization that
impedes an effective response to the epidemic. The IAS looks forward to returning to the US with the International AIDS Conference
when this country removes its barriers to the free and fair entry of PLHIV. We hope this will happen soon. ■
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© TOUCH BRIEFINGS 2008
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