UNAIDS chief: Today's HIV epidemic is 'completely different'

The health community is celebrating a victory in Addis Ababa, Ethiopia, this week: the successful completion of the 6th Millennium Development Goal for combating the HIV and AIDS epidemic. There are now 15 million people under treatment with antiretroviral drugs, and both new infections and mortality rates are declining. Now, the conversation is shifting from halting and reversing the AIDS epidemic to ending it completely by 2030. Devex spoke with UNAIDS Executive Director Michel Sidibe on the sidelines of #FFD3 to hear what it will take to achieve — and what stands in the way of — an AIDS-free generation. Does the political will at the country and international level exist to target resources to the communities most at risk and in need of those resources? I think it’s very important to not forget that we will never win against the disease when we exclude people. We are seeing that in Eastern Europe, in Central Asia, in the Middle East, in different parts of the world where people are not having access to services because they are criminalized because they are a drug user. It is the same with the countries with homophobic laws. What [U.N. Secretary-General Ban Ki-moon said in his remarks] is to be inclusive, to make sure that whatever we do is to not exclude the people because then we will not end this epidemic. … We are working with the countries. We are continuing to advocate, but I am seeing that from the perspective of health, and I personally feel that everyone should have access to his right. We will not also end this epidemic if we don’t deal with violence against women [and] young girls, who are also raped and [have] one of the highest infection rates; with a mortality rate [that] is going up when others are [declining]. We need to think about those vulnerables, those people who are in fragile communities and who are not reached. Some people are skeptical about expanding the mandate of HIV programs and funding beyond the individual disease. We hear concerns in the U.S. that now the U.S. President’s Emergency Plan for AIDS Relief is supporting things it wasn’t designed to, concerns about what we’ve signed on to. How do you respond to that concern? We need to understand that the epidemic is not anymore like it used to be 30 years back. What we are talking about today is an epidemic … which is completely different. We have multiple epidemics. If we don’t extend our understanding by using … what could be the driving forces of death. If it’s [tuberculosis] and we miss to link HIV and TB we will have a problem. If it’s reproductive health because of lack of knowledge … and we want to run away from those concepts, we’ll just expose young girls and young boys to major risk. It’s the same for reforming laws. With bad laws you know that people will just go underground. Gay people are not anymore reached in many places because of homophobic laws. I don’t think they are going beyond their mandate, because giving only pills is not changing the face of the epidemic. We are talking also about restoring [the] dignity of people. Is there one takeaway from this International Conference on Financing for Development from UNAIDS’ perspective? We need to understand that financing will be completely different in the post-2015 [era], that the world needs to start thinking about going beyond just [official development assistance], looking at domestic resources, and trying to also be innovative in terms of reducing cost. … Still, this shared responsibility and need, from my point of view, to pay attention to how to really sustain our effort to reach vulnerables. Devex is in Addis to give you the inside track on #Fin4Dev. Check out our running blog, and follow @Devex, @richard_devex and @AlterIgoe to get the latest news and developments from #FFD3.