Posted By: Tom Kenyon, M.D., M.P.H. on June 8, 2016

Labels: Africa , Global Health Expertise, Infectious Disease

How the Fight against HIV/AIDS changed global health

It seems unbelievable to those of us who remember the 1980s and 90s, but HIV/AIDS often seems regarded as yesterday's crisis. It no longer grabs headlines. That doesn't mean the fight against the disease is over -- in fact, far from it which is why the United Nations General Assembly is holding a high level meeting on HIV/AIDS over the next two days to rededicate the world to controlling the epidemic by 2030.

That we can even think of making HIV/AIDS history is the direct result of one of the most comprehensive and successful international public health operations in human history – one that can be a blueprint for the fight against future epidemics and pandemics. As President Barack Obama said in a statement ahead of the UN meeting: "The past 35 years tell a story that bends from uncertainty, fear, and loss toward resilience, innovation, and hope."

And as we consider how to confront other public health crises, including our recent challenge from Ebola and the current epidemic very much in the public eye, Zika and other threats to come, it's useful to reflect on why the HIV/AIDS fight has largely worked thus far.

Yes, it has taken resources, evidence-based approaches, and hard work. But for me, the most important watchword is: Perseverance.  There were times when the battle against HIV/AIDS looked dark indeed. But the many health professionals, governments, and NGOs, including Project HOPE, that were involved in the effort to combat the disease have never given up.  And this is what they have achieved. According to new UN figures released ahead of the conference, the number of HIV-positive people taking antiretroviral medicines more than doubled to an estimated 17 million people from 2010 to 2015, including two million people who were started on the lifesaving treatment last year alone.

Global coverage of antiretroviral medicines hit 46 per cent at the end of 2015 and progress was most notable in eastern and southern Africa, where coverage increased from 24 per cent in 2010 to 54 per cent in 2015, reaching a total of 10.3 million people. AIDS-related deaths fell from 1.5 million in 2010 to 1.1 million in 2015. But as deaths decline, we mustn’t forget the staggering mortality during the era when treatment was not available. We must persevere.

One of the most important cogs in the anti-AIDS machine is a U.S. effort: The President's Emergency Plan or AIDS Relief (PEPFAR) -- which debuted under President George W. Bush and has continued under President Obama. To date, the program has had staggering results. It has provided lifesaving antiretroviral drugs to 9.5 million people.  It has delivered HIV testing and counseling to more than 14 million pregnant women. And thanks to PEPFAR, more than one million babies have been born HIV free. It is highly significant that the program has not been an old fashioned top-down aid and emergency effort. It's been driven by health professionals and partnerships with governments in the most affected nations -- and in fact has done vital work in establishing sustainable public health systems that will be the backbone of improving health care -- especially in Africa for generations.

Just as importantly, governments and politicians from all persuasions, perhaps slowly at first but later with the full force that only coordinated international action can bring, recognized the danger from HIV/AIDS and the need to tackle it aggressively. That aspect of HIV/AIDS coordination provides a model for how bipartisan political efforts and diplomatic coordination actually work well to advance global health issues.

It's important that when we look back at the 35 years of fighting HIV/AIDS that we consider our successes -- that's how we can summon up the emotion and the political will to carry on the struggle -- and that's why the UN meeting is so crucial. But much remains to be overcome – including, stigma and discrimination, poor access to services, and lack of sustainable financing. 

The conference will look at ways to increase the commitment of individual nations to cope with various aspects of their own epidemic. This includes how best to finance new treatment regimes, how to find the right mix of motivated and knowledgeable leaders, and the use of new data techniques to identify marginalized populations.

It’s also a reality that people in countries affected by HIV/AIDS have finite resources to spend on their own health and there is more competition for those resources than ever before. Now that the threat from noncommunicable diseases is so evident, some governments must confront a new reality: "Do I buy diabetes, hypertension, and cancer medicines, or do I buy HIV medicines?"

And there are still parts of the world, including Nigeria and parts of Eastern Europe for instance, where the fight against HIV/AIDS is still not being won -- for all the success elsewhere. That is why meetings to set new goals and to examine current and future policy like the one at the UN this week are so vital. Global leaders need to set the stage for those who do the actual work.

And it comes back to that word:  Perseverance.  No person, government or country can fight HIV/AIDS or other health crises alone. We all share risk and we all need to share in the response.  And it’s not just true of this epidemic but other public health threats as well, both known and unknown.

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