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AIDS is not over: long-term, progressive leadership needed to change face of the epidemic by 2031

The following statement was issued December 1, 2009 on World AIDS Day by the Commonwealth, UNAIDS and the Institute for Global Health of Imperial College. It was issued at the Commonwealth Heads of Government Meeting in Trinidad. The Commonwealth is an association of 53 independent countries formerly a part of the British Commonwealth that today work together to promote democracy, human rights, individual liberties, good governance and world peace.

Michel Sidibé, Executive Director, UNAIDS, Geneva
Kamalesh Sharma, Commonwealth Secretary-General, London
Peter Piot, Director, Institute for Global Health, Imperial College, London

HIV/AIDS was the first global epidemic to be allocated a dedicated international day — and with good reason. As we mark this 22nd World AIDS Day, HIV/AIDS remains a lethal threat to millions the world over, despite progress in improving access to treatment and reducing new infections.

The Commonwealth is home to two-thirds of the world’s people living with HIV, including two-thirds of women living with HIV. But the Commonwealth also represents a huge potential for breaking the trajectory of the pandemic. The association’s 53 members share common traditions and values, in the same way that they share common aspirations and challenges. The Commonwealth has long-established networks of government and civil society partners, in health as well as in the related spheres of law, education, finance and gender. These networks can advance the cause of the Commonwealth’s work, for example, in overcoming the legal, social and economic barriers to universal access to effective HIV/AIDS prevention, treatment, care and support.

Universal access and human rights — the theme of this World AIDS Day — provides a case in point. AIDS often hits hardest the most marginalised populations. Legal frameworks in many countries exacerbate the situation by criminalising the behaviour of these groups that are most at risk of HIV. Such laws and other forms of discrimination can present real obstacles to delivering essential services.

When World AIDS Day was launched in 1988, the AIDS landscape was very different from today. Thanks to advances in science and medicine, changes in funding,and the courageous and persistent demands of people living with HIV, we now have anti-retroviral treatment to prolong the lives of people living with AIDS. Public information and education campaigns have improved awareness.

But AIDS is by no means over and, despite what some may think, there is still a significant funding shortfall from what is needed to manage the epidemic now and into the future. Treatment is not available for more than 5 million people who need it. Moreover, for every two people who start anti-retroviral therapy, five are newly infected — many of them young people. We are creating a growing, unsustainable load on public health systems, budgets and communities.

HIV will continue its devastating impact on sub-Saharan Africa, and will pose an increasing risk to communities in many parts of Asia and the Caribbean. Recent research, by the independent aids2031 initiative with support from UNAIDS, suggests that unless the world dramatically changes its approach to the epidemic, by 2031 — 50 years after AIDS was first reported — between 1 and 2 million people per year are likely to be infected with HIV, and developing countries could face an annual AIDS bill of US$35 billion.

Those who care about the impact of HIV on Commonwealth countries must accept that much of the response to the pandemic has been short-sighted and based on the hope that there will be some magic formula to address the complex social and economic challenges associated with the disease. In the long term, progressive leadership and effective management of the pandemic will require affirmative answers to five key questions:

Do we fully understand our epidemic? AIDS is strongly connected with specific social, economic and cultural realities to which each AIDS response must be tailored.

Are we actively engaging the individuals and communities affected by AIDS? Their experience and knowledge means they have much to contribute.

Are we doing the right things to continue to increase access to medicines, particularly second-line treatment? This may mean, for example, creating patent pools to drive down the cost of production and increase competition.

Are we doing all we can to bridge the funding gap — and tapping innovative financing mechanisms? For example, leveraging mechanisms such as the Currency Transaction Levy beyond the G-20?

Are we using funds as efficiently as possible by supporting cost-effective interventions that address the needs of the most vulnerable? We need improved targeting of resources and more intelligent prevention.

If we start answering these questions today, we may not need a World AIDS Day in 2031. Until then, this day provides an opportunity for all citizens of the Commonwealth to ask the right questions, and to come together to devise the best approaches to ensure universal access.