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World AIDS Day 2012: Realizing the Dream of an AIDS-Free Generation

David Wilson's picture

Unprecedented progress, promise and challenge mark World AIDS Day 2012. Science has given us the tools to defeat the deadliest epidemic of our age, and we dare envision – with U.S. Secretary of State Hillary Clinton – an AIDS-free generation.

Globally, we have an expanding armory of prevention tools, we have developed more drugs to combat AIDS than every other retrovirus in history combined, we have reduced AIDS drug costs from more than $10,000 to under $100, and we have extended AIDS treatment from under 50,000 less than a decade ago to more than 8 million today in the most rapid scale-up of lifesaving treatment in history.

According to the latest UNAIDS report, new HIV infections have declined by more than 50% in 25 low and middle-income countries. AIDS-related deaths have fallen by more than 25%. Yet AIDS remains the deadliest infectious disease of our age, still responsible for over 65 million infections and 30 million deaths cumulatively, and roughly 3 million infections and 2 million deaths a year.

Infectious diseases – primarily AIDS but also tuberculosis and malaria –  still account for almost two-thirds of mortality in Africa. Almost four million children in South Africa alone have lost at least one parent to AIDS. Global AIDS financing has stagnated and more than 20 countries in Africa rely on external funding for over half of their AIDS budgets.

Our global success in fighting AIDS illuminates our wider fight against disease, ignorance and poverty. It attests to the transformative power of four critical elements:  science, solidarity, human rights, and bold action.

Our remarkable scientific progress against AIDS exemplifies decades of accelerating scientific advances in many fields. Continued innovation in science, technology, implementation and social organization offer unprecedented opportunities to end disease, ignorance and poverty – provided we harness them fully.  Yet scientific innovation alone was insufficient to transform the global AIDS response until it fused with the unprecedented solidarity of a coalition of conservative and liberal legislators, scientists and activists, northern taxpayers and southern communities that refused to limit lifesaving AIDS treatment to the affluent and today dares to envision  a generation free of AIDS.

AIDS shows us – not simply as a principle, but as a clear, empirical, observable truth – how human rights are a prerequisite for health and development. Effective HIV prevention – whether among marginalized women, sex workers, men-who-have-sex-with-men or injecting drug users – means promoting human rights as well as science and services. AIDS treatment is founded on the moral principle of a right to care – and asserting this right for AIDS treatment has energized a wider drive for universal health coverage.

The emphasis on rights transformed AIDS from a deadly disease to a wider social movement – for people with AIDS, the marginalized, health as a human right and ultimately for universal human rights.

The global expansion of AIDS treatment stemmed not from careful analysis and evidence of feasibility – but from a moral commitment to action and to visionary goals that seemed unattainably bold at the beginning of the epidemic. It stemmed also from a burning impatience with process and an unremitting drive for results – in shortening drug approval times, reducing drug costs and introducing large-scale treatment where none existed.

The collateral benefits of the AIDS response are immense and growing. A recent Journal of the American Medical Association study showed countries receiving U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) resources reduced adult mortality from ALL causes by 20%. Health platforms strengthened by the AIDS response are delivering remarkable declines in infant mortality in East Africa.

An immense, concentrated surge of resources focused on delivery transformed frontline health services. The AIDS response inspired the birth of the global health movement and led to a step-change in global resources for health.

In Africa, it regenerated a dying continent, banishing the grim spectre of hospitals overflowing with dying stick figures and coffin makers lining highways to overflowing cemeteries. Today, seven of the 10 fastest growing economies are African. and the continent’s growth surprises even the optimists.

In so many ways, AIDS exemplifies the amazing social and scientific progress we have made in our lifetime.  With an AIDS-free generation in sight, let us not falter. With a redoubled commitment to scientific innovation, solidarity, rights and action, we can realize the dream of an AIDS-free generation. Ending AIDS is both an end in itself as well as a major milestone in the quest to end disease, ignorance and poverty.

Comments

Submitted by Anonymous on
I wish the World Bank (and indeed the rest of the world too) would go back to public health fundamentals and instead of presenting a compelling case for one issue - invest time presenting evenhanded analysis of financing challenges and opportunities for multiple issues in a way that helps support more efficent investments and allocations overall. While there are clearly efforts to do this, we are still starting from a skewed position - not just at the Bank, but globally (including at the Global Fund for AIDS TB and Malaria where financing is 52%, 32%, and 16% respectively). The loudest single voiced advocacy dictates investment patterns and it tends towards the atonal braying kind, rather than a harmony between voices that ought to be raised together when there is common cause. The classic example of this is the asymmetric response to HIV and TB by the Bank and other development partners both in staff, analytic work, and financing. Apart from the many other health challenges worthy of support and engagement - Africa indeed has an HIV/AIDS epidemic, but also a TB epidemic, and a TB/HIV epidemic - the latter two are woefully neglected. Every year 1.1 million people living with HIV get sick with TB and 1 in 4 AIDS deaths are due to TB (430,000 people living with HIV die from TB each year). Africa now has the highest number of TB deaths (HIV+ and HIV-) of any other region. Is is also not on track to reach the TB MDG-related target of 50% mortality reduction by 2015 unlike other regions that are on track. This is due to HIV/AIDS on one hand, and a breathtaking (excuse the pun) negligence by the international community to address TB and to co-epidemic of TB/HIV. For example, for every $100 going to Africa from the Global Fund, $6 is for TB. It would be interesting to compare Bank investments in HIV/AIDS and TB over the last 5 years... To illustrate the skew - here are some figures on total global donor financing per year: HIV/AIDS - $6.9 Billion Total deaths - 1.7 million (430,000 of which are TB deaths among HIV+) Malaria - $2 Billion Total deaths - 655,000 TB - $480 million Total deaths - 1.4 million (430,000 of which are TB deaths among HIV+ ...yes, these are the same that are counted in HIV/AIDS) The bottom line is that when a person with HIV dies of TB it is a public health failure. When major investments in HIV are made in countries struggling with a co-epidemic of HIV and TB - and there is limited or no effort to address the co-epidemic, it is irresponsible and dangerous (...and inefficient). It is exciting that PEPFAR's blueprint for an AIDS-free generation puts addressing the TB/HIV co-epidemic as its first priority under it's 'roadmap for smart investments' - it's exciting because no major player in global health has prioritized this before. The Bank is well placed to provide leadership and momentum here - but there is little evidence that this is happening (yet)... signed - impatient, but optimistic

Thank you for your comments, which I very much agree with - my blog should have stressed the links between HIV and TB. I noted briefly that 60% of mortality in Africa was due to infectious diseases, primarily HIV but also TB, but I should have followed this with arguments for integrated HIV and TB programming. HIV greatly increases TB and TB remains the leading cause of death among HIV patients. Concerning financing, I would note that funds identified as HIV resources have positive impacts upon TB too. For example, AIDS treatment has reduced HIV/TB mortality by 13% in the last 10 years. You're right to applaud PEPFAR's Blueprint for an AIDS-free generation for its focus on HIV/TB co-morbidity. It's also worth mentioning that on December 3 UNAIDS and the Stop TB Partnership announced a new partnership to tackle HIV/TB deaths in Africa. The initiative will focus on 10 countries that account for 75% of HIV/TB mortality - Nigeria, Ethiopia, India, Kenya, Mozambique, South Africa, Tanzania, Uganda, Zambia and Zimbabwe. We also need to promote integrated programming for HIV, other sexually transmitted infections and major blood borne infections, including hepatitis C. Once again, thanks for your valid comments, I'll be sure to emphasize integrated TB/HIV programming in future and please feel free to follow-up with me individually if you'd like to discuss this issue further.

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