International AIDS Conference 2016: Monday 18th July. Nelson Mandela Day.

Day 1. Up at 6.45am feeling well rested. It is nice and sunny, considerably warmer weather than the weekend. I think I can safely say now that I am not jetlagged. How does this happen when a few hours on a plane to the US has me not knowing what day it is? It is good to know I can fly to SA without this problem. I have a shower and wash my hair whilst Rolande borrows my Mac as she has yet to successfully connect to the internet and needs to read her email. Miraculously, I never has such problems for a change.Once again I check my days programme but because of the pre-conference, this morning is rather quiet. I am looking forward to this evenings plenary event dedicated to Nelson Mandela. We have breakfast abit later at 9am after which I catch up with things online myself. Still a sunny day we decide to explore abit of Durban and leave after 11am. We walk.


Once we leave the local area and walk into the town centre, taxi drivers keep approaching us. Rolande tells me it is unusual for white people to be on foot. It is busy and we see lots of shops with open fronts and a market. I was surprised to see a big Woolworths store. This isn't the scenic area near the ocean. I end up sweating and we decide to get a taxi to the ICC which is just over 2 miles away. These taxis are people carriers and it costs R5 each which is just 25p.
Once there we got to the Global Village and sit down in the eating area. Rolande has a beer and I have a hot water.
We go to the Global Village session room 1 for 3.30pm for our first conference session. This is meeting the NGO delegation for the UNAIDS Programme. 5 members in total. We sit at the front. They are all nice people but alas our host speaks too fast and too quietly and we and most other delegates can't understand him which is a shame.

They tell us that UNAIDS is about global policy setting on HIV, it is not a funding body. Each of the NGO reps are HIV+. They tell us about a report on sexual reproduction rights which is on the UNAIDS website.
Back at the Global Village its time to sample the local cuisine. We take our time and Rolande ends up eating a chicken pitta wrap for lunch but since I arrived in Durban I have been curious about this:

 I have seen these stalls all over our venue and in Durban and think I have figured out what they're serving after being confident it isn't rabbit lol. I see people walking away from these places with plates of rice, chicken/beef and veg. It looks nice.

As I like to try new things especially food of other lands I ask for a chicken bunny chow. The girl laughs at me and gives it to me. It was wasn't what I expected but I have to take it now anyway. It is half a loaf of bread with chicken curry on top. Very strange lol and too much bread for me so I leave most of that whilst eating the curry. R70 (£3.50) for this. At least my curiosity is satisfied and I know for sure what a bunny chow is. Washed down with a can of grape Fanta.



I get over this by taking a selfie in my red ribbon t-shirt.

Our next event is at 5.50pm in the Global Village film screening room. I have looked forward to this and we sat at the front. We watch a 40 minute film called AIDS: NGO's from all over the world. I enjoy it even more so than the previous event which was about the same thing really. This film is now on Vimeo.
Rumour has it that Prince Harry is appearing at this conference. That would really be something but I haven't seen it mentioned anywhere official and not in the programme.  Anyway we head to the ICC for the plenary event of the day, to session room 1 which the size of a stadium. We can't get any closer than half way along. Although billed as starting at 7.30pm it starts late at 7.50pm. Mandela's grandson is up first followed by Charlize Theron who gives a heartfelt and empassioned speech about how HIV doesn't discriminate.She was awesome and the audience and south africans clearly love her. She was cheered after every sentence and got a standing ovation. Quite a few technical faults but nobody cared about this.

South Africans don't need much of a reason to get up and dance and this is what the do near the beginning of this even which seemed at the mercy of technology.




Desmond Tutu was meant to be here but he made a video speech instead which was shown.

There were 3 performers intermingled among the speeches and other speakers included Prof. Chris Beyrer from John Hopkins University, Michel Sidibe from UNAIDS Switzerland and C.Rupert a south africam filmmaker. Our volunteer friend Katie left at 8.50pm but not before giving us each a yellow bracelet, bless her. This even is running so late and powerful and fun as it is we leave at 9.25pm. Back in our room we have a hot drink, water for me and find the AIDS Conference on tv which is showing the Mandela event. Thats lucky, we watch it until it finishes at 11pm. Another day done.And what a day, a great start!

International AIDS Pre-conference 2016: Sunday 17th July

We rise at 7.30 and have breakfast before heading off to the ICC. I'm not looking too bad considering I went to bed at midnight. We go straight upstairs to find session room 11. My stomach is still abit upset as it was yesterday. I am late to the start and end up with Rolande on the front row. I find myself sitting next to Francois Barre-Sinoussi! This mornings session is more science intensive than yesterday. This turns out to be true all day much to my delight. This 9am session is entitled HIV Latency and reversal strategies.

Our first speaker was Miles Davenport from Australia talking about SIV in macaques. Using SIV to study latency generates alot of diversity over a small area.

Next was Alexander Pasternak from Amsterdam University. He talks about what determines the rate of viral suppression after ART initiation and concludes that unspliced RNA is not predictive.






The third and last speaker in this session was Andrew Badley from the mayo clinic talking about why reactivating cells dont die. Strangely I don't have a photo of him. Reactivating cells are programmed to resist cell death. It has been found that a BCl2 antagonist promotes the death of reactivating cells.

 At 10am a speaker named Eric Cohen from Montreal University spoke about broadly neutralising antiHIV antibodies.

Then Georgio Bozz from the National Cancer Institute talked about how HIV genetic diversity increases over time. HIV in tissue and blood is analysed and found to be detectable 12 hours post mortem. 



After a coffee break, the next session includes several speakers and a poster session at 11am.

First up is Prof. Olivier Lambotte from Paris University. He speaks of how onocology can help HIV eradication. The goal for cancer and HIV is the same, to kill or control rare events.cellular therapies are effective in both HIV and leukemia.

 Then we had Dr Anna-Marie Wensing from Utrecht University. She spoke about Epistem, a consortium of 6 projects. Patients recieve a transplant and multiple biopsies are taken. In time it was found that only traces of HIV DNA was detected. Great to hear a positive outcome.

 Next was Dr Chris Peterson of the Fred Hutchinson Cancer Institute.
He spoke of the road to a functional cure and mentioned the only example of this to date, the Berlin Patient, Timothy Brown. Transplantation depletes T Cells. The proportion of long term grafted stem cells were increased and it was found that early grafting i.e. the most edited gave most effective results. There is a need to evaluate T cell gene therapy as an alternative/complement to stem cell gene therapy. Though I have never got around to looking this up, I have often wondered if there were any scientists anywhere looking at the approach which worked for Tim Brown. I am so pleased, over the moon, to discover that there are. Left this session feeling happy though more talks to come  yet. 

Another researcher from Utrecht University, Monique Nijhuis. She spoke of current ART therapies and concluded that gene editing is the way to go in future. 

 Li Haung from Duke University, North Carolina.Her aim is to identify a compound which can work on the 'kill' phase ( in the shock and kill technique). So far a possibility is Gindimacrin which is potent and exhibits good selectivity.

The final speaker is Jintanat Aranworanich who works with drugs which have different modes of action. There is rebound though with treatment interruption. The drugs are well tolerated by most patients though. She concludes that alternative strategies to reduce or eliminate HIV reserviors are needed. 

 Rolande and I spend alot of time at this poster with its owner having a great discussion.








It is now 12.30pm which is lunchtime. On our way out of the room we are handed a voucher for lunch downstairs. Sounds exciting though I am still not feeling hungry. The dining room is huge with lots of good food to help ourselves too. I want to eat but don't have much. I have alot of mixed salad, some chunky mixed veg, a bit of stew which turns out to be  a potato and bean curry which is very nice. Also a few mixed veg noodles. I had a tiny dessert too. Over lunch Rolande asks me out of the blue if I would like to be on the board of advisors of Chemists Without Borders. I never expected this question but I  would be honoured and flattered to be. I said that yes I would if I were asked. I will have to see where that leads. It made me happy though and made me think of the fact that I have been on the scientific border of advisors for The Rutger Hauer Starfish Association now for a year already.  After eating Rolande and I head to the Global Village and end up watching 10 minutes of a talk already in progress: Coast of Dreams. This earned us a pink dot on our lanyards.
The 2pm session sees us back in room 11 for a table discussion moderated by Judith Auerbach.

  
The theme is bridging the gap between biomedical and social sciences towards an HIV cure.
Access  to information in HIV in Africa is still scarce and this needs improvement. Evidence based information is needed for public understanding. Research carried out in the US needs to be then translated so it can also be done in Africa.
During the Q&A it is pointed out that a 'cure' for AIDS isn't the same as talking about an actual cure say for example, for TB where a cure does mean a cure.
A coffee break at 3.10pm includes scones which I can't resist even lunch hasn't digested yet. I'm glad I had one, it was nice and light. The next session begins at 3.25pm but I am late again as my SA tummy bug has me dasing to the bathroom again. The theme of this session is the immunology of HIV persistence.

HIV DNA in lymph nodes. This is studied by looking at SIV replication in macaques. 






  

Dr Barbara Feller from the NIH Cancer Institute. She looks at cytokine (hetl-15) production on a large scale in macaques. This is a unique immune system agonist for cancer and HIV immunotherapy.

 Dr Jean-Pierre Routy of McGill University, Canada. Looks at both PD-1 expression in mice and PD-1 block with ART in macaques. Found to give an increase in proliferation and function of CD cells. In conjunction with other therapies, this may give additional benefits. 





At 4.30pm:Dr Julia Prado from Irsi Caixa discusses shock and kill therapies.

She uses a 'resting like' HIV-1 reactivation model (RELI)









The last speaker from Emory University os Ann Chakroudi. 

An SIV RNAscope in situ hybridization in macaques. ART was well tolerated and leaves very little drug in the brain.

  





Next a young chinese researcher was presented with an award for her research. Then the closing speaker Prof. John Wherry of Pennsylvania University spoke of how a cancer cure could be used to treat HIV. He spoke of the development and reversal of T cell exhaustion.

This is common in mice as well as in humans.





So this is the end of a very full pre-conference for me and I am really pleased I had come to this. It does help you settle in and give a flavour of things to come for newbies like me. I have learnt alot so this makes me happy. The night is not over yet though and we go to the official opening of the Global Village which begins at 6pm. They are running late as we wait patiently wait outside and also once inside. Ithought we wouldn't get a seat but we were lucky enough to get on the second row again. The major of Durban is among the speakers and one of the Master of Ceremonies was an HIV+ 5 year old girl called Cammie who was a muppet!

We enjoyed a tribal dance, a rap dance and a beautiful song in tribute to Nelson Mandela.








What I really liked and was moved by was a powerful poem read by a man but from the perpective of a woman who is a mother. It tells of the myth and cost of having sex with a child/virgin which prevents you from getting AIDS. Tells of the great losses and pain felt by a mother in this horrible situation.

 There was also a musical group called the Sexphonics and this required audience participation, we had to sing along. We were in the section called semen and this is the word we had to sing. Definitely different.

So the Global Village is now open and this was a fun evening though I feel tired. We decide to walk around it for a glimpse of all it has to offer. Something nice which caught my eye was a 'Solidaritree'. It was very colourful and I noticed 2 ladies hanging red ribbons on it so went over to investigate. I see now that the ribbons have writing on them so I took one and wrote Starfish web address on it and hung it up. Not many on it yet, early days.....
A taxi back to our hotel

I buy £20 (R400) worth of phone vouchers from reception. Our thoughtful  host also managed to get us a new door key cut so that Rolande and I have one each.  I charge my phone and look at the conference programme planning tomorrow, the first day. Bed at 11pm. 

International AIDS Pre-conference 2016: Saturday July 16th

Today, is the first day of a 2 day pre-conference and we get up at 6.45am. After breakfast Rolande, Prakash and I jump straight into a Heavenly Shuttle which takes us to the ICC for R80 (£5).  Each time you enter this place you and your bags have to go through a security check.Scanned just like at the airports. I thought I'd seen the last of that for a few days lol.
The pre-conference is intense and there a many concurrent sessions going on and lots of choice of different topics within the HIV field. Before attending delegates must register online for a maximum of 3 areas. This strikes me as strange as they are all happening at once and it is impossible to be in 3 places at the same time. They fill to capacity quickly and I found that the most 'scientific' ones had already been filled, but I found one which I am very happy to attend as it is what we all want and will update me on the latest info. Namely 'Towards an HIV cure'.

The pre-conference and the conference itself are composed of talks, poster sessions, workshops, poetry readings, film screening, networking opportunities and so much more. As each delegate can choose what to attend, everybodys conference and experience will be different, so if you are interested, I encourage you to seek out the blogs and reviews of other attendees and see what they did and learned. The premutations are endless........
So, the first session of 'Towards an HIV cure' began at 9am and I got in easily as I had preregistered.  Rolande was not so organised and it took some time for her to appear. I have learned that she knows how to get herself into places and to get things done. As we were to do for most sessions, we sat on the second row. This session was introduced by the co-founder of the HIV and Nobel laureate Francois Barre-Sinoussi herself! She defined HIV cure and said the main priority in science these days is getting papers published but this shouldn't be the case. She is right.

On each of our seats was a green and a red card for us each to hold up if we agree or disagree with some statements we were given to think about by the next distinguished speaker Anna Laura Ross. Firstly she asked if community was an active part of the HIV cure. Without hesitation I held up my green card and saw that Rolande and many others near us had put up a red card. No rights or wrongs but not all communities are involved in this. I hadn't thought of that so maybe I won't be so hasty next time. Then she said 'a cure is an essential part of ending the epidemic'. I was happy to be in agreement with the majority as I put my red card in the air. No, a cure and ending an epidemic are not the same things at all. Finally, she said 'curing HIV will end stigma'. Red cards. Wouldn't that be great though? This session ended with us being asked to think about what it meant to be HIV cured and what the legal implications of this would be. This was a nice gentle and interesting start which took us to 9.30am when the second session began. This consisted of 3 presentations on the basics of the science behind an HIV cure.
First up was Asier Saez-Cirion talking about the hurdles to an HIV cure.

The virus can persist undetected in lymph nodes. Also one thing I never think about but makes sense is that the virus is found in tissues as well such as the brain and lungs, it isn't just in the fluids. The HIV virus works by integrating itself into the genetic information which then forms part of an 'HIV reservoir'. Whilst viral multiplication can be stopped there is (as of yet?) no way to get rid  of this reservoir. The virus can be followed using animal models and the virus also persists due to infected memory cells. Two strategies have been deveopled to deal with this. Eradication which doesn't mean a person is protected, and control of HIV-1 infection. Early treatment seems to  favour this. An interesting Q & A followed. The second talk was given by Sharon Lewin and Gus Cairns  about current strategies and ongoing clinical trials. This retrovirus fools the immune system and one option is to make HIV invisible so that the immune system never sees it. This is difficult to achieve for a lifetime. Another major problem is that this virus comes back very quickly within weeks if antiretroviral therapy (ART) is stopped. The 2 Boston patients were mentioned, they had been in remission for just a few months. The Mississippi baby was clear of HIV for 28 months. This viral rebound as it is known, is not understood. The Berlin patient is very rare and unusual indeed. Two main strategies for dealing with this are decreasing the persistance of the virus which will increase immunity, and trying to shock the virus for latent infections. This has progressed to clinical trials but shocking alone doesn't work. Possible to enhance immunity using T cell  vaccines and there are alot of new ones. Also gene editing 'CRISPR'.The last presentation of this session was given by Judith Auerbach and David Evans talking about integrating social reseach into HIV cure. The key areas here are the stakeholder perspectives i.e. patients, clinicians, policy makers. Also the public understanding of science,  access and equity, and HIV identities. The morning ended with a quick talk at noon by Kevin Osborne, Advocating an HIV cure. He talked about what is needed and what isn't. What is happening and what isn't.
There were lots of similar looking eatery stalls scattered outside around the venue. What a great place! Rolande and I went to one of them and found a table where we could acquaint ourselves with whoever wanted to join us. It was suddenly very windy. I have a large chicken pasta salad which I really enjoy and a bottle of water I had brought with me. Again not expensive, at R35 my food cost less than £2. Prakash found and joined us and started talking about his work. A cure for HIV involving mercury? I tell people about The Rutger Hauer Starfish Association the AIDS non-profit which has a firm grasp on my heartstrings and I show them my now very tatty leaflet which I got from a fundraiser back in 2012.
The afternoon session begins at 2pm and takes place in the same room (5). There were 3 introductory speakers, firstly Jack Whitesciver then the President of the National AIDS Society Dr Chris Beyrer who tells us there are alot of femail speakers at this conference and they had over 7000 abstracts submitted! Then Barre-Sinoussi speaks and tells us that the 1st AIDS Symposium was in Vienna in 2010. Incidently this is the second time this conference has taken place here in Durban, the first time as 16 years ago in 2000. Next Sharon Lewin introduces the first speaker, none other than Dr Anthony Fauci of NIH who talks about the challenges persistant in HIV research. His lab recently used transfer of monoclonal antibodies on an exploratory study of 30 people with chronic HIV infection. They all rebounded no matter what.

The next steps  are eradication vs sustained remission. This involves state of the art gene editing techniques such as the aforementioned CRISPR. There is also passive infusion of combinations of 3 or more long lasting antibodies. 


  

Next up was a South African speaker Gethwana Mahlase talking about movng towards an AIDS cure involving community. She has her own NGO and said that the introduction of ARV's means taking 1 pill a day and alot of people forget. She spoke of there being 10 funerals a week in her community. The way forward is more research, effective drugs, community work and meaningful partnerships.
The next session started at 3pm and Dianne Rauch introduced a british speaker Andrew Phillips from UCL who spoke about identifying the key drivers of the impact of HIV cure intervention in sub-saharan Africa.

This was the first time during the pre-conf I had heard of the word 'cure' being replaced by 'suppression'. It won't be the last time and I like it, its more accurate.





After a coffee break a special session begins at 4.30pm. This is about paediatric HIV and there are several speakers. I find this a very emotional session and feel its my favourite one so far. Is it because its about kids? Oh so young. Two speakers introduced by Deborah Persaud. The first is Deena Gibbons from Kings College London talking about the relevance of paediatric immunology to HIV persistance.

  

Next up was Nigel Klein of UCL talking about the comparison of babies and adults. Over the age of 5 years old, the capacity to generate CD4 count diminishes. Overall conclusion here is that infants have a

 better immune response. 

An amazing table discussion begins at 5pm with a diverse range of people and very interesting topics. I find this a powerful session too. They include Paolo Rossi of Rome who chats about why childrens model is essential to advancing HIV, Caroline Tenneson who speaks of mother to child transmission. This was moderated by Jintanat Ananworanich from the US military HIV program. I was very touched here by a south african lady called Barbara Kinsley. She has been HIV+ for 16 years and was in denial for the first 8 years but had to face up to it when she got sick. She got better once on ARV's and started running. She is now an activist and an ultramarathoner. Her message was that we need to take care of pregnant women as no infant should be born with HIV. Positive reinforcement is needed. Maybe I was moved because she is a fellow runner who cares about the same subject. Two things in common at least. She spoke beautifully and the Q & A was also great. Todays sessions all took place in session room 5 on the ground floor in the middle of the building. We were somewhat bemused by a pigeon who kept putting in an appearance appearing from the rafters but never flying over the audience. He just hovered above the speakers. I think he has something to say or wanted to ask a question.

It is now 6pm and there is a poster and networking session at the front of the room which will go on all night. 

A nice french lady spoke to me whilst I was admiring her poster and told me she was speaking at 2 sessions this week. She spent ages telling me about her poster/research. Alas I wish I had taken a photo of it and can't think now why I didn't.







There was a wide variety of food available which waiters brought around for us. I was still full from lunch but it looked so good I eat anyway. There was a variety of alcohol available which my colleagues enjoyed and I had one can of Castle beer which I made last all evening.Sometimes not being aable to tolerate booze is a bummer!  This was a lively fun session, being able to mingle, meet and chat to likeminded people and exchange business cards and stories etc. Rolande certainly took advantage of everything on offer and it was good to see her enjoying herself. I kept wandering around to look at posters, meet new people and stretch my legs. Plenty of great people stopped off at our table to say hello.  I wish I could recall the name of the jolly kenyan guy we chatted to. Sorry dude.

L to R:Kenyan delegate, Rolande, me and Prakash

There are lots of lovely volunteers here who have come from far and wide. Tonight Rolande and I befriended a lovely botzwanan called Katie. We would see her working at the conference and when she had time she would come and seek us out bless her heart! I love anyone who loves hugs too. We were the last to leave and got a taxi back to our lodge. We got there at 8.30am. I was surprised to see puddles on the floor as a sign that it had been raining. Time to recharge out phones and laptops and catch up with emails etc. Amazing where the hours go. We had coffee and watched abit of tv before recharging our own batteries at midnight. It rained all night too xxx 

International AIDS Pre-conference weekend 2016: Friday July 15th, arriving in Durban.

Flying from the UK to South Africa takes more than a day so I won't  bore you with the details. I got there via Schipol, Cairo and Johannesburg on Friday 15th July. We landed at 10.15 am and it was a clear 30 degree day in Durban. My hint that this conference had taken over Durban were the conference banners and people waiting for delegates, also volunteers easy to spot in their bright t-shirts. The lovely helpful volunteers were able to put me on a shuttle and get me a return ticket for R160 which is about £8. I am happy I don't need to worry about getting back here for my flight home. Just seeing the volunteers made me happy too. My hotel wouldn't you know it is not on the designated route and the driver is keen to take me to the ICC (International Conference Centre) which I need to visit at some point today to register and  get my ID/lanyard for the week. I am fine with this but hope I don't have problems finding my guesthouse. I also get to wondering how and when I will meet up with my german colleague with whom I am sharing a room even though we have only corresponded online so far. She is Dr Rolande Hodel, founder of AIDSfreeAfrica and she does most of her work in Cameroon which she loves. I had hardly been here long already but enough locals had told me that this was their winter. I love all seasons but this is my kind of winter I think as its still warmer and sunnier than the UK in July. Once at the ICC, it didn't take me long get my photo ID and lanyard but then I had to join a long queue to get my conference materials, with my suitcase of course. As I queued and got closer to the desk I turned around and there behind me talking to a guy was Rolande! I made myself known and knew already that she had been here one night. We both laughed at the chances of this happening out of more than 18k delegates! She introduced me to the indian guy she was talking to whom she had met in our hotel at breakfast. His name is Prakash and the 3 of us would spend most of the pre-conference and conference together.  I am keen to get to hotel to check in and drop off suitcase, and have a shower as I have been on planes and in airports for over 24hours. Prakash very kindly phones a taxi for me and its a firm we end up using half the time with the name of Heavenly Shuttles.  He is a nice man. Another cab firm which tickles me  goes by the name of Mozzie Cabs lol. When my ride arrives Rolande hugs me even after I warn her I'm all sweaty. We tell each other we are happy to see each other. Cab to our lodge costs R80 which is approx. £5. Such lovely views here wherever you look, an ocean drive and palmtrees everwhere. Once at our lodge which up a hill, I shower, get to know my home for the next week and shower. Then its time to charge phone and Mac and sort out the usual tech probs which I can't seem to avoid when traveling.

view from room balcony

Another view from our room

Main entrance to venue

Rolande returns when I am sat emailing. We have an empty fridge in our room and decide to walk down the hill to a supermarket she discovered yesterday. I was amazed at how cheap everything is. I buy crisps, a yoghurt and a chicken salad sandwich. Wine is cheap and Rolande buys a carton for £1.50 but I am abstaining at the moment as part of my half marathon training, especially as I'm not running this week. The very nice and young guy on our hotel reception sells me a SIM card he had originally bought for himself to help me with my phone woes. Really appreciate that! Once in our room we spend evening  on our laptops and eating and drinking. I look at the pre-conference program deciding which events I want to see tomorrow. As we put out the lights I marvel at the fact that I am wide awake having just travelled 6,099 miles and I dont feel any jetlag just yet. Is it too early to tell? Also can't believe that all those miles and the time difference is just one hour ahead here in Durban. Weird but amazing...xxx  

International AIDS Conference 2016

I was very excited to attend my very first AIDS conference which this time took place in Durban, South Africa. I was at the pre-conference too as advised and am so glad that I went.

I had a great time but was distracted somewhat and could've had a better time. My heart was in Dublin though with my mother who was in a hospice.
I will be back soon with many entries talking you through my conference.

Love Sarah xxx

Books!

On the 5th of this month of June I visited Keele University for a CLEAPSS health and safety course. Afterwards I visited their on campus Blackwells book store not really expecting or needing any new books. However, so much great literature on offer. I couldn't help but buy these beauties.

So thats my summer reading taken care of! :D