The historic return of the International AIDS Conference to Durban was a moment to celebrate the advances made against the AIDS epidemic in the last 16 years as well as to contemplate the journey ahead. Perhaps more than any other 16 years in history, the period between AIDS 2000 and AIDS 2016 teaches us how much we can achieve if we galvanize the power of humanity for a cause.
In 2000, when the world gathered in Durban for the first international AIDS conference in Africa, the disease was raging. For most, AIDS was a death sentence. Rich people could access the newly available treatment, which cost nearly US$10,000 a year; poor people couldn’t. So the poor died of AIDS, by the millions. That injustice – along with personal pleas from an 11-year-old boy called Nkosi Johnson, who was dying of AIDS, and from world leaders like Nelson Mandela – galvanized the global health community to act.
Today, antiretroviral therapy for people living with HIV costs as low as US$94 a year. More than 17 million people are on treatment – half of them through Global Fund-supported programs. AIDS-related deaths have dropped by 41 percent. Never before in the history of global health has a disease galvanized so much goodwill.
While AIDS 2000 shouted to the world the inequalities between the rich and the poor fuelling HIV, AIDS 2016 profiled the inequalities between the general population and groups that remain stigmatized and discriminated against. AIDS-related deaths among adolescents have more than tripled, making it the second-leading cause of mortality in that age group. In southern Africa, the disease is disproportionately borne by young women and girls, where it infects more than 6,000 girls a week. Key populations, such as transgender people, men who have sex with men, and people who use drugs are excessively affected by HIV. For instance, transgender women are 49 times more likely to be living with HIV than the rest of the population. That is unacceptable. And it highlights that HIV is as much a disease of societal and cultural norms as a virus, and therefore, medical solutions alone are insufficient. To control the HIV epidemic, we need to become better people and give flight to the better angels of our nature.
Despite strong evidence that treatment reduces the transmission of HIV by reducing how much of the virus is circulating, there was a very sobering reminder that success in carefully managed studies in selected populations does not always translate in the real world. An important study showed that increased treatment in a high-transmission area had no impact on prevention. Perhaps highlighting even more the human side of efforts to end HIV as an epidemic.
AIDS 2016 also shone a light on the uncertainty in the future of the HIV response. Participants were concerned about the place of the response amid increased global priorities and changing political landscape. Others articulated concerns about declining levels of funding for research and development and for treatment and prevention programs in the HIV field.
These are fundamental concerns. A report by the Kaiser Family Foundation and UNAIDS issued ahead AIDS 2016 shows that donor government funding to support HIV efforts in low- and middle-income countries fell for the first time in five years in 2015. In addition, we now expanded the evidence-base to show that new HIV infections, in particular among adolescent girls and young women, have shown no decline in the past 5 years. This evidence demonstrates that there is an urgent need to expand combination HIV prevention packages. Also critical is that there are still millions of people waiting in line to start HIV treatment. A global goal of reaching 30 million people with HIV treatment by 2020 has been set. With 17 million people now on treatment, that means putting an additional 13 million people on treatment in the next four years. That will require more funding, and more commitment.
But there was hope from the conference as well. At a time when the world seems to be looking inward, at a time when hate and violence has dominated the news cycle, more than 16,000 people gathered in Durban and unequivocally stated that love and sacrifice and commitment to serve others is a greater purpose we all should pursue.
AIDS 2000 called on the world to step up the fight against HIV and AIDS. We did, and in 16 years we have made progress that we didn’t dream of at the time. AIDS 2016 told the world that the fight isn’t over – and that the hard-fought gains of the past 16 years could gradually unravel if we do not sustain the investments and the commitments we have dedicated to this cause.
In September, the world has an opportunity to recommit to the fight against HIV and AIDS, as donors, governments and activists gather in Montreal, Canada, to raise funds to enable the Global Fund partnership to continue its work around the world to fight AIDS, TB and malaria, and to build resilient and sustainable systems for health. The Global Fund is seeking US$13 billion for the three-year period starting in 2017. Combined with significant increases in domestic financing and maintenance of other external funds, this investment will save eight million lives, bringing total lives saved by the Global Fund partnership to more than 30 million by 2020. If we fail to invest collectively, not only can we not move towards ending HIV as a public health threat, because of the significant increase in the population of young people, we are at a very high risk of losing control of the epidemic.
Promoting a bigger social justice agenda is the only way to end AIDS. It will be much harder to make the quick progress and impact we made in the last 16 years. But today, we have an advantage over 2000: we now have the knowledge and tools to end HIV, TB and malaria as epidemics. Together, we can be the generation that lost control of the epidemics or we can be the generation that ends these diseases as epidemics. For good.