Concrete target: A boy walks past graffiti made to mark World Aids Day, outside a government building in Maputo, Mozambique. 

Picture: Themba Hadebe / AP
Concrete target: A boy walks past graffiti made to mark World Aids Day, outside a government building in Maputo, Mozambique. Picture: Themba Hadebe / AP

Opening doors for dialogue

By MICHEL SIDIBÉ Time of article published Jun 21, 2011

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We look back at the past 30 years of Aids, so that we can shape the future of the response. About 65 million people have been infected by HIV since it was first reported – and nearly 30 million people have lost their lives to it.

Global reaction was slow at first. Then, in 2001, world leaders signed the Declaration of Commitment on HIV/Aids at the UN. In the intervening years, goals have been set, breakthroughs have been announced and progress has been made.

In 2006, countries committed to reaching goals towards universal access to HIV prevention, treatment, care and support. Today more than 6.5 million people are alive thanks to access to antiretroviral therapy.

Investments for Aids have increased by more than 900 percent since 2001. Prevention is working, with a 25 percent drop in the rate of new HIV infections.

The news has got better and better. New HIV prevention options such as CAPRISA gel, a female-controlled microbicide, and iPreX, a pre-exposure prophylaxis, have emerged, giving hope to people who want to protect themselves and their loved ones from the virus.

Firmly held ideologies have in many places been replaced with compassion and doors have opened for dialogue. Evidence is being embraced by political leaders when making policy decisions.

It is no longer uncommon for activists, communities affected by HIV and policymakers to plan together, ironing out differences and exploring new frontiers. The global solidarity for the Aids response has shown what humanity can achieve when they get together.

We need more of the above, a lot more.

Today, the Aids response is bursting at the seams. The demand for prevention and treatment is increasing. Opportunities abound – and we can seize them if we move on five fronts.

First, embrace the benefits of treatment for prevention. People living with HIV can, for the first time, choose a method that is 96 percent effective and which they can initiate and manage with respect and confidence. Treatment for prevention must be an option for all people living with HIV. But this should not have to come at the cost of the 9 million people who are eligible and waiting for treatment for their immediate survival. Additional treatment for prevention must be made available.

Second, pregnant women living with HIV need to have access to the best possible treatment regimen to protect themselves and their children. Thirty one countries still use suboptimal regimens to prevent mother-to-child transmission of HIV. In high-income countries few children are born with HIV. There is no reason it cannot be the same everywhere. The life of a child and a mother have the same value, irrespective of where they are born and live. We can eliminate new HIV infections among children by 2015.

Third, there has to be space for community dialogue and social transformation.

Violence against women and girls, intergenerational sex, homophobia, gender inequity and criminalisation of people living with HIV, people who inject drugs or sell sex must end.

Without such transformation, HIV prevention measures will be only partially effective. This will require the leaders in rural and urban communities and capitals to break the silence about these issues and act boldly, with conviction.

Fourth, Aids investments must be made in full. This should be through a new shared responsibility agenda, where every country, rich or poor, puts in its fair share – no exceptions, no excuses. A deferred investment today will have a multiplier effect on investment needs in the future: a prospect no finance minister will like to face.

At the same time, the health community must accelerate innovation in diagnostics and treatment, reduce unit costs, increase efficiencies and invest in programmes that work so that there is more value for the money invested.

Finally, the Aids response has to integrate with broader health and development programmes. The Aids response has to come out of isolation and become the catalyst for achieving the Millennium Development Goals related to health – especially reducing infant and maternal mortality as well tuberculosis. Health care delivery must not remain in silos.

From June 8 to 10, world leaders gathered at the UN in New York for the 2011 General Assembly high-level meeting on Aids.

It proved to be a watershed moment in the global Aids response.

We witnessed a strong recommitment to the Aids response by member states, as demonstrated in the new declaration and its bold new targets for 2015: to reduce sexual transmission of HIV and HIV infection among people who inject drugs by half, to increase the number of people on treatment to 15 million, to halve TB-related deaths in people living with HIV and to further push towards eliminating new HIV infections among children.

For the first time in any UN declaration, key populations – men who have sex with men, people who inject drugs and sex workers – were named, and member states urged to tailor HIV prevention strategies for populations where epidemiological evidence shows that they are more vulnerable to HIV infection.

These are concrete targets that will bring hope to the 34 million people living with HIV and their families. They deserve nothing less.

l Michel Sidibé is the executive director of the Joint UN Programme on HIV/Aids and under-secretary-general of the UN.

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