This time 10 years ago, world leaders of what was then the Group of Eight made a historic commitment to universal access to HIV prevention, treatment, care and support by 2010. United Nations member states went on to make the same promise at the U.N. world summit in New York just two months later.
We’ve come a long way in a decade, that’s for sure. But we cannot yet say that we are anywhere near achieving universal access. AIDS-related deaths have fallen by 35 percent since the peak of the epidemic in 2005 and the number of new infections continues to decline annually. That’s the good news. Nonetheless there are thought to be around 35 million people living with HIV globally; 19 million don’t currently know their HIV-positive status. Of those people who need antiretroviral drugs, only just over a third have access. That’s the bad news.
As the Group of Seven leaders gather on June 7-8, this time in Bavaria, Germany, the moment is ripe with significance as the world is poised in September to give birth to the sustainable development goals that will replace the Millennium Development Goals. One of the goals aims to ensure healthy lives and promote well-being at all ages. It also includes a commitment to end the AIDS epidemic by 2030.
We have the scientific know-how to end AIDS and every month seems to bring news of another biomedical advance that could change the trajectory of the epidemic once and for all. Last week the preliminary findings of the Strategic Timing of AntiRetroviral Treatment trial confirmed that early treatment is best for HIV. Indeed the findings were so compelling that the study was stopped a year early so that all the participants could receive medication. Earlier in the year the PROUD study looking at transmission among men who have sex with men found that taking a daily pill, truvada, can cut the spread of HIV by 86 percent.
These are exciting times for those of us working in the HIV field and give cause for huge optimism that it could be possible to achieve the recently adopted UNAIDS Fast Track targets — which aim for no more than 500,000 new infections among adults by 2020 and no more than 200,000 by 2030 — and also have a genuine shot at ending the AIDS pandemic. While we can and should be galvanized by and feel renewed optimism at the global acceptance of the goal to end the AIDS pandemic by 2030, we must also recognise that this goal is only possible if several key factors are in place.
Firstly, there must be a continuation of the political and financial will from key donor governments to finish what they started and make the final push to eliminate the AIDS pandemic. Donors must continue to invest multilaterally (through effective mechanisms such as the Global Fund) and bilaterally (through direct donor support to countries) in countries where people are most infected and affected by HIV. This means underpinning and building the HIV response in low-income countries with a high disease burden but also supporting middle-income countries (where over 70 percent of people living with HIV will be by 2020) to establish sustainable domestic HIV responses that meet the needs of all those affected by the disease and particularly the most marginalized and vulnerable.
South Africa, Nigeria and India have some of the highest HIV burdens globally yet these are the very countries that donors in the “global north” are starting to withdraw from. Without a careful and supported transition to domestic funding, the provision of essential services to groups most at risk of HIV, as well as efforts to defend their human rights, will almost certainly be undermined.
The other critical side of this equation is the responsibility of domestic governments to prioritize sufficient financing for the HIV response, maintaining and developing inclusive health system governance and implementing and funding effective programming that is directly tailored to meet the needs of people living with and affected by HIV in their national context. This will require a funded and active civil society to provide services, mobilise uptake and hold government and service providers to account. We need to look for example at the legal and structural barriers that continue to lead to a failure to protect those who are most vulnerable to HIV, in particular marginalised populations like men who have sex with men, transgender people, sex workers, and people who inject drugs. Punitive laws need to be rescinded, behaviours decriminalised and health services made stigma-free.
At the 2007 G-8 summit in Heiligendamm, Germany, Chancellor Angela Merkel et al. reasserted their intention to “scale up their efforts to contributing towards the goal of universal access to comprehensive HIV/AIDS prevention programs, treatment and care and support by 2010 for all.” Eight years on, global health will again play an important role in this year's G-7 summit under the German presidency and it is to be hoped that the G-7 will not only make a firm commitment to end AIDS by 2030 but also this time make the rhetoric a reality once and for all.
Mike Podmore is an advocacy and coalition specialist who has been working in the field of HIV, health, gender and human rights for 13 years. He is currently policy manager with the International HIV/AIDS Alliance and will shortly be joining StopAIDS as their new director.
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