As an African woman, the memories of AIDS are etched on me: of family members taken too soon, leaving us bereaved and broken; of countries’ development plans thrown off course; and of fearing that this threat might be impossible to defeat.
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But I have other memories that bring me strength — mostly, of how people started to fight back, often at huge personal risk. Their bravery changed everything, and we were able to mobilize science, international resources, innovation, and partnerships to start making progress against the epidemic. And the progress made against the epidemic is a miracle — not handed from above, but brought about by communities working together.
But we must be cleareyed. The job is not done, and the last mile is the hardest. It is time to reach for the high-hanging fruit. Without doing so, AIDS will remain undefeated, the Sustainable Development Goals will be at risk, and millions of people will be left behind.
To end AIDS, we need a new era of leadership — serious, courageous, just — in the following areas:
1. Leadership to bring health to all. Health care is a human right and should never depend on how much money you have in your pocket. Activists demand cutting-edge medicines and health care for people living with HIV, delivered affordably and to scale, no matter where they live. That vision is at the heart of health for all. Governments must provide publicly funded health care for everyone through progressive tax systems in which the superrich and large corporations pay their fair share. Public health systems must deliver services that reach people most in need, and governments must support communities of people living with and affected by HIV to take community-led service provision to scale.
2. Leadership to end gender inequality. Young women and girls, particularly in sub-Saharan Africa, face an unacceptably high risk of HIV infection while services are not always well designed to meet young people’s needs for comprehensive sexual and reproductive health services. Leadership needs to remove structural obstacles that deny women and girls their rights, equal opportunities, and power.
Ensuring comprehensive primary and secondary education must underpin equality — but leadership also needs to confront rules and customs that keep girls and women down. Addressing gender inequality requires long-term commitment to change laws and policies and personal courage to speak out for the rights of women and girls. Leaders must listen to women’s movements to learn what they need.
3. Leadership to end discrimination. The HIV epidemic will continue while marginalized communities — including LGBTQ people, men who have sex with men, people who use drugs, sex workers, prisoners, and migrants — live in fear of the state or of sanctioned violence and abuse. Too often, leaders lack the courage to challenge deeply ingrained prejudice or shore themselves up by indulging stigma and discrimination. Leaders must face down baying crowds and stand up for zero discrimination and the right to health for all citizens, understanding that the collective public interest is hurt by punitive approaches. Listening to marginalized groups is key; they know the legal protections they need.
4. Leadership on democratic scientific innovation. The AIDS response has always been at the forefront of innovation — moving from an HIV treatment regimen costing $10,000 per year with eight pills per day to one costing $74 per year with one pill per day and from facility-based to community-led service delivery. The pace of science and innovation is accelerating, with the risk of misuse to further victimize and exploit the marginalized or of their denial to people most in need. We require democratic scientific leadership that engages in respectful dialogue with affected communities and that is guided by ethics, human rights, and social justice.
5. Leadership from across society. Business, the media, trade unions, faith groups, community organizations, social movements, and cultural influencers all have a role to play. Breakthroughs happen when businesses speak out in favor of universal health care, when the media promotes human rights and stops perpetuating damaging stereotypes about the effectiveness of punitive approaches toward people who use drugs, and when faith leaders call out homophobic prejudice or violence against women and girls.
6. Leadership from the United Nations. UNAIDS is responsible for coordinating the AIDS response, but we are not the boss — we are a servant. We must be steadfast in defending universal human rights when pressured not to and in calling out practices that are unjust or not evidence-informed. We need to be humble and inclusive and work to reinforce the leadership of others — of civil society in its broadest sense and particularly of communities affected by HIV. This is more vital than ever.
Leadership is hard and involves difficult choices. But leaders remembered with honor are not those who do what is popular or politically expedient in the moment, but those who do what is right. It is said that where there is a will, there is a way. I believe there is a way, and we will together find the will. This must be the decade of acceleration in the fight against AIDS — a decade of leadership.
When we tell the generation not yet born about the story of AIDS, let us share with them three memories: the memory of when AIDS first hit us, the memory of when we started to fight back, and the memory of consigning AIDS to memory.