At the International AIDS Society’s annual meeting in Rome last month, there was a lot of good news. Chief among it was the presentation of solid evidence that antiretroviral therapy does more than treat HIV — it can also prevent the virus.
New findings from the HIV Prevention Trials Network have demonstrated that early treatment for people living with HIV can reduce sexual transmission to their partners 96%. The Partners PrEP study has found that giving antiretroviral therapy to the HIV-negative partners of those living with HIV can reduce their chances of acquiring HIV up to 73%. And there is further evidence that male circumcision is effective in preventing HIV in men.
But amid all the good news, one stubborn fact was hard to ignore: AIDS remains a metaphor for inequality.
In the world’s wealthier nations, where access to medicine is widespread, AIDS is becoming a chronic disease rather than a death sentence. But in the developing world, 1.8 million people die of AIDS each year. In the Northern Hemisphere, we are seeing a new generation born HIV-free, while each year in the southern half of the world, 370,000 babies start life infected with HIV. In the southern region, 9 million people living with HIV are still waiting for treatment to survive.
It is hard not to conclude from all this that life is not valued equally across the world. This is morally wrong and unacceptable.
A mother should not have to choose between treatment for herself and treatment for her newborn. People should not be dying of AIDS when treatment is available. It is morally wrong that babies are still being born with HIV when we know how to prevent it, and it is morally wrong that children are still growing up as AIDS orphans.
At a recent United Nations High-Level Meeting on AIDS, member states unanimously adopted a Political Declaration on HIV/AIDS that sets bold new targets for 2015. But even as the fight against the virus is starting to turn, some countries have reduced their contributions to the worldwide effort.
Now is not the moment to retreat. We must see beyond the near-term costs toward the long-term benefits of innovation and investment for AIDS.
If we want to turn scientific successes into progress for the poor, we must overcome the forces that threaten access. We have to scale up, even as some donors are scaling back, and we have to use innovation to overcome social division and inequity.
We urgently need to move forward on five fronts.
First is developing a new generation of options that will lower treatment costs, deliver smarter drugs in smarter ways, and provide better approaches to HIV testing, diagnostics and delivery.
Second, we need new ways to make sure life-saving services reach everyone who needs them quickly. We need to increase treatment literacy at the community level, increase demand for services, and improve delivery on the ground. We must also work with countries, the pharmaceutical industry, international organizations and NGOs to ensure that new discoveries are accessible to all who need them.
Third, we must reduce the time it takes for research findings to be integrated into policy. Currently, it still takes about one year to get research results published, then five to 10 years to translate them into public health policy, and three to five more years to gear up to implement them on a national or global scale.
Fourth, we need better primary prevention of HIV. We must focus on hot spots where transmission is most likely to occur, especially to reach women and girls; men who have sex with men; migrants; prisoners; people who buy and sell sex; those who inject drugs; and others whose access is blocked by stigma, discrimination and criminalization.
Finally, we must leverage the networks created to combat HIV, using the reach, resources and lessons of the AIDS movement to improve global health beyond HIV and bring a wide range of life-saving discoveries to the poor.
The AIDS virus does not move slowly, and neither should we if we are to hope to achieve our collective vision of “zero new HIV infections, zero discrimination and zero AIDS-related deaths.”
Michel Sidibé is executive director of the Joint United Nations Programme on HIV/AIDS (UNAIDS) and under secretary-general of the United Nations.