By Lilianne Ploumen
09 June 2016
There was a time when we could say that humanity had no control over Aids, but this is no longer true. Yet only last year, 1.1 million people died of Aids-related illnesses, and 2.1 million more were infected with HIV. An estimated 19.7 million people living with HIV are not receiving antiretroviral treatment. This is not due to our inability to tackle Aids; rather, it is a manifestation of inequality in all its forms – social, cultural, economic and gender-based.
It isn’t lack of drugs preventing us eradicating AIDS, but inequality.
Often, different forms of inequality go hand-in-hand: rape survivors, for instance, run an extra high risk of being infected with HIV. More often than not they are poor – and so are their rapists. Once infected, they are very likely to become ill and die and, although there are medicines to prevent this, many people don’t have access to them. This inequality doesn’t only affect the world’s poorest regions. About 60% of people with HIV live in middle-income countries. That figure illustrates an alarming phenomenon: although inequality between countries is fading, inequality within countries is growing. On the one hand, incomes in middle-income countries are rising, a middle class is emerging and healthcare is improving. On the other hand large groups of people are not benefiting from this progress.
The New York Times
By The Editorial Board
The world has made so much progress in reducing the spread of AIDS and treating people with H.I.V. that the epidemic has receded from the public spotlight. Yet by any measure the disease remains a major threat — 1.1 million people died last year from AIDS-related causes, and 2.1 million people were infected with the virus. And while deaths are down over the last five years, the number of new infections has essentially reached a plateau.
The United Nations announced a goal last week of ending the spread of the disease by 2030. That’s a laudable and ambitious goal, reachable only if individual nations vigorously campaign to treat everyone who has the virus and to limit new infections.
The medicines and know-how are there, but in many countries the money and political will are not. Besides shining a spotlight on the disease, it’s crucial that wealthy nations like the United States continue to pony up generously to underwrite what must be a global effort. Donors and low- and middle-income countries need to increase spending to $26 billion a year by 2020, the United Nations says, up from nearly $19.2 billion in 2014.
While still high, deaths attributable to AIDS are down 36 percent from 2010. That is largely because many more people are receiving antiretroviral drugs — 17 million people in 2015, compared with 7.5 million five years earlier. These medicines allow people to live near-normal lives and greatly reduce the risk of transmission to others.
But while some countries like South Africa (once a disaster zone) and Kenya have made tremendous progress in increasing treatment, many people who need the lifesaving therapy do not have access to it. Only 28 percent of those infected in Western and Central Africa were being treated in 2015, according to a recent United Nations report. The numbers were even lower in the Middle East and North Africa (17 percent) and Eastern Europe and Central Asia (21 percent). In some countries, people who test positive are told to come back when they get sick because of budget constraints, says Sharonann Lynch, an H.I.V. policy adviser at Doctors Without Borders. Many never return.
In other places, it can be hard to even reach people who need drugs because of war or the lack of a functional public health system. And many who need help are unwilling to come forward because they fear being ostracized or worse because they are gay, use drugs or are engaged in sex work. Discriminatory laws and attitudes in countries like Nigeria, Russia and Uganda have probably forced tens of thousands of people who need help into hiding.
In some countries, infections have actually increased, which helps explain why progress has plateaued over all. In Eastern Europe and Central Asia, for instance, 190,000 people became infected last year, up from 120,000 in 2010. And while the number of deaths is way down, the number of new infections was flat or down modestly over the same five-year period. This was also true of the United States, where an estimated 44,073 people were diagnosed in 2014, the most recent year for which the Centers for Disease Control and Prevention have published data, down from 44,940 in 2010.
These numbers do not argue for complacency, but instead for more vigorous public health campaigns, increased access to condoms, clean needles for drug users and prescriptions for pre-exposure drugs. There is still no cure for AIDS. But there are many ways to minimize its deadly consequences.
By Elton John and Desmond Tutu
8 June 2016
This week, world leaders are gathering at the United Nations to act on a groundbreaking goal: to make AIDS history. And while the goal is undoubtedly ambitious, it is achievable if we commit the political will and resources to make it happen.
The progress we have already made in the battle to contain AIDS is quite extraordinary. It is evidence of the irresistible power within the human family, when individuals, communities and countries work together to achieve common goals, to make the impossible, possible.
It was just 15 years ago, in 2001, that the United Nations convened the first High Level Meeting on HIV/AIDS.
At the time, we faced a global nightmare that looked like it would be with us for generations. The horror was palpable. Lifesaving treatment was too expensive for many, and health care systems in many poor countries too weak. Infant mortality was tripling, life expectancy was plummeting, and families, communities, economies and even some countries were teetering on the brink of collapse. Years of hard-won development progress were being wiped out overnight.
Hope and opportunity were scarce, and much-needed action seemed frozen by fear, denial and stigma.
No one knew what to expect at that meeting. Even beginning to turn the tide on AIDS seemed out of reach, but that’s just what the world came together to do.
One-hundred-and-eighty-nine states ratified the U.N. Declaration of Commitment to Fight AIDS. The United States government enacted the $30 billion President’s Emergency Plan for AIDS Relief, the largest global health initiative in history. Donors and partner governments created the Global Fund for AIDS, TB & Malaria, which has saved 17 million lives by supporting country-driven health care systems.
The results of the world’s commitment have been unprecedented. More than 15.86 million people living with HIV now have access to lifesaving treatment, new HIV infections have been cut by more than one-third for adults and nearly two-thirds for children, and AIDS deaths have dropped by more than 40%. All in all, 30 million new infections and 8 million deaths have been prevented by our work together. It’s hard to beat that kind of real world return on investment.
Moreover, AIDS investments have paid dividends many times over by positively impacting other development priorities like improving health care systems, preparing for other emerging health crises, reducing maternal and infant mortality, and promoting human rights, gender equality, civil society and democracy.
Now, the Joint United Nations Program on HIV/AIDS has stated, we have the science, the tools and the solidarity to actually end AIDS by 2030.
But our sense of urgency has not subsided and more work lies ahead. Last year alone, over 2 million people became infected with HIV and another million died of AIDS. If we do not pick up our pace and simply continue HIV prevention and treatment services at their current level, our progress will slip backward and the epidemic could again explode. But if we leverage our current momentum and, over the next five years, accelerate our scale-up for the people, places and programs with the greatest impact, we can save millions more lives and billions of dollars.
The world leaders at the 2016 High Level Meeting on Ending AIDS this week have another historic opportunity — this time to pass a political declaration that translates our vision for fast-tracking the end of AIDS into a road map for concerted action. Making this happen will require bold leadership and shared responsibility from heads of state from the north and the south; ministers of health; program implementers; faith, business and foundation leaders; civil society and all the other partners that have helped bring us to this fragile tipping point.
This would surely include the LGBT organizations that some have been trying to keep out of this meeting. In our view, progress is made by bringing people together, not pushing them apart.
We urge leaders from around the globe to be actively engaged in the High Level Meeting and help secure a global compact that commits to: fast-tracking and front-loading investments over the next five years, setting ambitious but doable global prevention and treatment targets that keep us on track, and leaving no one behind by ensuring that human rights remain at the center of the AIDS response, especially among marginalized populations in challenging settings. This is not a time to coast or move on, but to focus and accelerate.
Those on the front lines of this epidemic and their allies around the world know exactly what we need to do and are well on the path to getting it done. But more will and wallet remain essential. Sadly, experience has too often left the African landscape littered with great ideas and good intentions that stopped short of accomplishing their goals. We cannot afford to let our fight against AIDS go down that road. We have come too far, we are too close to the end and there is far too much at stake.
We have the ability and opportunity to save lives and build AIDS-free futures. Let’s seize the day and make AIDS history.
By Scott Barnhart
The world is too complicated for disease-specific approaches to health, as the ravages of Ebola in weak health systems have shown. A health-system strengthening approach will ensure that, especially in times of austerity, there are local institutions and infrastructure in place to provide care for all.
|The President’s Emergency Plan for AIDS Relief (PEPFAR) 3.0 has embarked on an important refocusing to achieve epidemic control through 90-90-90 (90% of HIV-positive individuals knowing their status, 90% of those receiving antiretroviral therapy, and 90% of those achieving viral suppression).1 and 2 Despite good intentions, the implementation is creating health-system disruption. For example, in Zimbabwe, a voluntary medical male circumcision programme will now serve ten instead of 21 districts. Ambassador Birx, referring to these programme cuts as “efficiencies”, touted that funds will be freed up “for the greatest impact.3” Although this might optimise impact in areas of the highest HIV/AIDS burden, medical sites are being triaged, with patients losing services and investments being wasted. Concentration on fewer districts also leads to poaching of health workers from already understaffed sites elsewhere.|