‘Ending AIDS’ is possible in our lifetime. Possible, yes. But we are not on pace for it quite yet. Indeed the achievements reported are real, and they’re saving millions of lives and promoting inclusive development throughout the world.
But at our current rate of progress we are unlikely to achieve the UNAIDS goals of zero new infections, zero AIDS-related deaths and zero HIV-related stigma.
Here are three clear milestones to look for to know when the end is in sight.
1. Bridge the funding gap
Last year globally more than $17 billion (UNAIDS) was spent on the response to HIV. This is a significant achievement and something that was virtually unthinkable a decade ago, especially given the current climate of government austerity.
It’s also $7 billion short of the minimum that is needed to achieve our goals (UNAIDS). There are two ways to close that gap – increase the allocations for AIDS programmes or make the current funding levels go much further. In reality a mix of both of these two will likely be required.
In recent years, unprecedented support has been provided through multilateral funds like the Global Fund to Fight HIV, Tuberculosis and Malaria and the U.S. President’s Emergency Plan for AIDS Relief. These funding mechanisms have allowed for the breakthroughs that have led to this week’s positive news.
And already the Global Fund and UNAIDS have put a greater emphasis on achieving efficiencies in AIDS programmes. But most of the funding gap will need to be funded from domestic budgets. AIDS funding will need to be ‘regularized’ in government budgets so that it is not dependent on unpredictable donor giving patterns.
2. A shift in social attitudes
Despite the increased funding and the achievements reported, the global AIDS response still does not focus enough on the populations most affected by HIV.
Thirty years into the epidemic, we’ve learned what prevention measures work. Now it is a matter of consolidating the political will to protect these populations, who often reside on the margins of mainstream society.
The recent proliferation of homophobic legislation in the region shows that policymakers are not ready to promote enabling legal environments. This is why the United Nations has supported the work of the Global Commission on HIV and the Law.
The issue goes beyond politicians though, and touches on what societies are comfortable with supporting.
With the holidays approaching I was looking at the websites of some of the larger international charities. I found sites that gave me the option of targeting $50 to the price of textbooks for girl students, vaccines for infants and housing for those who most need it.
I didn’t see the option to pay to keep a bath house in stock of condoms and lubricant, or to provide a year’s worth of clean needles and syringes to a prisoner. But such programmes have demonstrated their cost effectiveness, and are essential for reversing the epidemic, especially in Eastern Europe and Central Asia.
3. Treatment begins to outpace new infections
If any indicator can be said to provide a proxy scoreboard for how we are doing in the response to AIDS it is the ratio of new HIV infections to people initiated on antiretroviral (ARV) treatment.
In addition to saving a person’s life, ARVs reduce the viral load to levels that makes transmission of the virus virtually impossible. This is why the strategy for ending AIDS has to be comprehensive and requires substantial investments in both prevention programmes and treatment scale up.
According to the UNAIDS report, last year 2.5 million people were newly infected with the virus, while only 1.4 million people were initiated on ARV treatment.
If the 2011 numbers had been reversed, we could know that we were on pace to approach the UNAIDS goals. The trends on these numbers however are encouraging. Access to ARV therapy increased by 63 percent in the last 24 months and the number of new infections continues its slow, steady decline.
Given the contradicting statistics reported in recent years, it is difficult to know whether or not we are on the brink of an AIDS-free generation.
Most likely, we will learn to live with, and manage, the virus in the coming decades. The worst fears of a plague-like global HIV pandemic have passed and the virus is beginning to be regarded as a chronic, but manageable disease. It’s not ideal, but this should be counted as an enormous accomplishment.
There is actually a fourth way to overcoming AIDS once and for all:
When we’ve read that a safe, affordable and effective vaccine has been discovered, tested, approved, transported and provided at scale throughout the world, we will know the epidemic has been defeated. One can always dream.