Cross-posted from NIH Office of AIDS Research, Director’s Corner

The 24th International AIDS Conference (AIDS 2022), held July 29 to August 2 in Montreal, Canada, and online, brought together researchers, policymakers, health practitioners, civil society leaders, advocates, and other partners working to end the HIV/AIDS pandemic. This conference marked the first time that the international HIV research and advocacy communities have gathered in person since 2019.

The conference had a significant global presence in concert with strong representation from the U.S. government, including the White House Office of National AIDS Policy (ONAP), the U.S. Department of Health and Human Services (HHS) Office of Infectious Disease and HIV/AIDS Policy (OIDP), the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), and the National Institutes of Health (NIH). Federal officials shared progress in the Ending the HIV Epidemic in the U.S. (EHE) initiative and implementation of the National HIV/AIDS Strategy.

NIH at AIDS 2022

NIH-sponsored HIV/AIDS research was an integral aspect of formal presentations and informal discussions throughout the conference. More than 100 presentations highlighted NIH-funded research fueling advances in implementation science, HIV-related stigma and discrimination, cure, vaccine development, and more.

Examples of sessions involving NIH staff include:

• A workshopExit Disclaimer, organized by National Institute of Mental Health (NIMH) staff, on advancing HIV health communication science to improve messaging among key populations, with remarks by NIH OAR staff;
• A satellite session, co-organized by NIMH and NIH OAR staff, to launch a special issue of the American Journal of Public HealthExit Disclaimer highlighting innovative theory and research on HIV-related intersectional stigma and discrimination;
• A satellite session on implementation science tied to a special issue of the Journal of Acquired Immune Deficiency SyndromesExit Disclaimer;
• A satellite session, organized by NIMH, on the role of behavioral economics and conditional incentives in strengthening HIV treatment and prevention;
• A workshop on infants, children, and adolescents with perinatal HIV exposure, moderated by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD);
• A session on current approaches to HIV vaccine and cure research, co-moderated by the National Institute of Allergy and Infectious Diseases (NIAID); and
• A satellite session on ethical considerations and community engagement for experimental medicine trials in Africa, with a panelist from NIAID.

Anthony S. Fauci, M.D., Director of NIAID, delivered a plenary address, where he discussed approaches for HIV cure and vaccine research. In comments to HIV.gov, Dr. Fauci charted the historyExit Disclaimer of HIV vaccine development efforts, pointing out the difficulty in eradicating the virus from reservoirs even after the virus has been suppressed to undetectable levels.

The NIH OAR, as the coordinator of the NIH HIV/AIDS research program, collaborated with colleagues across the NIH to collect highlights during the conference that may inform the NIH HIV/AIDS research agenda. Scientists from eight NIH Institutes, Centers, and Offices (ICOs) shared insights from conference sessions on topics such as innovations in diagnostics, prevention, and treatment; community engagement; and inclusion of all people affected by HIV when implementing programs. ¹

Community Engagement and Global Learning

AIDS 2022 underscored the value of NIH-sponsored HIV/AIDS research and its overall impact on public health for those with, or affected by, HIV. Central to this discussion was the importance of community engagement in HIV prevention and treatment. Recent research has led to breakthroughs in HIV testing, prevention, and treatment; however, these innovations must be tailored to meet the needs of diverse communities affected by HIV. Among other venues and opportunities, this was especially highlighted during my tour through the AIDS 2022 Global VillageExit Disclaimer.

The focus on community engagement and global learning was underscored by a site visit to two co-located community-based HIV clinics in Montreal. ONAP coordinated the visit for the U.S. delegation, which was led by Admiral Rachel L. Levine, M.D., HHS Assistant Secretary for Health. The clinics demonstrated how community engagement can remove barriers to HIV services. Their innovative models leverage technology to enable clients to complete screenings and schedule appointments online, self-test on-site, and learn results via telehealth appointments. These innovations, along with flexible hours and a status-neutral model that provides HIV and STI testing, prevention, and treatment services all in one place, make it more convenient for clients to access interventions. As ONAP Director Harold Phillips said in our joint interview with HIV.govExit Disclaimer, “The clinic was really patient- and person-centered. … I would love to see that kind of ease and access to STI testing in the United States.”

AIDS 2022 presented opportunities to learn from other countries that have reached HIV/AIDS epidemic control. While the United States has not yet achieved this goal, at least 20 countries have done so or have met the 90-90-90 HIV treatment targets, in part through PEPFAR support.² PEPFAR successes in HIV service delivery and programs that meet the needs of diverse communities abroad can inform research and public health efforts in the United States. In an HIV.gov interviewExit Disclaimer I gave with Ambassador John Nkengasong, Ph.D., the U.S. Global AIDS Coordinator, we stressed the importance of research in making these success stories possible and the critical need for more research in the areas of behavioral and social science, implementation science, and communication science.

Prominent Discussions About U=U, PrEP, Vaccine, and Cure

Other AIDS 2022 highlights spanned health communication science and advances in HIV prevention, testing, and vaccine research, including:

• The health communication campaign U=U, which promotes the message that undetectable is untransmittable;
• The applicability of lessons from HIV in responses to COVID-19 and monkeypox, including pandemic preparedness, surveillance and contact tracking, program implementation, and the need to address stigma and discrimination;
• Efforts to ensure equitable access to pre-exposure prophylaxis (PrEP), both within the United States and globally, as well as advances in PrEP formulations and implementation;
• Advances in diagnostics, such as multiplex technologies that test for both HIV and other infections like hepatitis and STIs, as well as creative distribution, through pharmacies, vending machines, and mobile services, that facilitates private self-testing and has the potential to expand access to health care and reduce stigma;
• Vaccine development, including the acceleration of early Phase 1 trials of candidates using mRNA technology, compared with previously tested platforms;
• Vaccine candidates that produce broadly neutralizing antibodies (bNAbs), which can combat a wide range of genetic variants of HIV hidden within the body, driving research toward a potential cure; and
• HIV management throughout the lifespan, with presentations on pediatrics, adolescence, pregnancy and breastfeeding, and aging.

AIDS 2022 was a welcome moment for the global HIV/AIDS community to come together, in a hybrid format, to share insights and affirm the commitment to end the HIV/AIDS pandemic. To learn more about NIH participation, visit the NIH OAR website. To learn more about the conference generally, visit the AIDS 2022 websiteExit Disclaimer.

^{1 -  ICOs participating in the data call included the Fogarty International Center, the National Institute of Allergy and Infectious Diseases, the National Cancer Institute, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institute of Diabetes and Digestive and Kidney Diseases, the National Institute of Mental Health, the Office of AIDS Research, and the Office of Research on Women’s Health.}

^{2 - PEPFAR, PEPFAR 2022 Country and Regional Operational Plan (COP/ROP) Guidance for all PEPFAR-Supported Countries, January 2022.}