The 4th Decade of AIDS: What is Needed to Reshape the Response

The international community has reached the first part of Millennium Development Goal 6: halting and reversing the spread of HIV. At least fifty-six countries have either stabilized or reduced new HIV infections by more than 25 per cent in the past ten years, and this is especially evident in sub-Saharan Africa, the region most affected by the epidemic. New HIV infections among children have dropped by 25 per cent, a significant step towards achieving the virtual elimination of mother-to-child transmission by 2015. In addition, today more than five million people are on antiretroviral treatment, which has reduced AIDS-related deaths by more than 20 per cent in the past five years. However, with more than 33 million people living with HIV today, 2.6 million new HIV infections, and nearly 2 million deaths in 2009, the gains made in the AIDS response are fragile.
In June 2011, world leaders will gather at the United Nations General Assembly to recommit to the AIDS response. This High Level Meeting on AIDS is timely, as it will be ten years since the 2001 Declaration of Commitment on HIV/AIDS, and five years since the world pledged to achieve universal access to HIV prevention, treatment, care, and support.
The opportunity presented by the High Level Meeting is monumental. The global community has the unique responsibility of setting the global AIDS response toward the path of zero new HIV infections, zero discrimination, and zero AIDS-related deaths.
At the meeting, world leaders will be encouraged to construct a new shared responsibility agenda, and a new global social compact for HIV that addresses the rapidly changing dynamics of today's world. With funding availability for the AIDS response dropping, the traditional governance and financing regime is no longer sustainable. It will be pertinent for world leaders to explore ways to harness the opportunities presented by the increasing role of emerging political powers in development, and the strong economic growth in many countries that have the ability to allocate more domestic resources towards funding their national AIDS responses. However, a new compact is needed -- one which seeks an optimum balance between external and domestic resources on the basis of a country's capacity to pay and its burden of disease.
The second fundamental area to be addressed in June will be to promote a global renaissance of HIV prevention. Nothing short of an HIV prevention revolution will take us to zero new HIV infections. The best approaches of the current response must be boosted by rapid access to tools that have become available over the past few years or are currently in development, such as male circumcision, antiretroviral gels and pills used to block HIV transmission including in infants, and increased treatment availability. Coupled with this prevention revolution is the imperative to overcome human rights violations and ensure that laws work for, not against, our common efforts.
Reversing and ultimately stopping AIDS requires the implementation of a comprehensive response incorporating innovations from the political, social, economic, and scientific realms, as well as the full use of existing and cost-effective technologies. I am convinced that the AIDS response can learn from, and partner with, other sectors that have successfully increased demand and sustained markets though continued innovation. Although the environment for the development of innovations is changing, with the involvement of new and different stakeholders from both public and private sectors, discussion is required on how new technologies may allow us to achieve universal access to HIV prevention, treatment, care and support.
Leaders and young women gathering in New York will have the platform to identify those game changers that will help the AIDS response spark transformation for young women and girls, and enable them to act as agents of change. Of all the pressing issues confronting the AIDS response today, the impact of HIV on young women and girls is one of the most urgent to address. In southern Africa, young women are up to five times more likely to become infected with HIV than young men. Addressing the social and structural determinants that make young women and girls more vulnerable to HIV will work towards self-empowerment, and turn the tide of the epidemic.
The last important area on the reshaping agenda is to ensure better linkages and synergies between HIV and tuberculosis, maternal and child health, other communicable and non-communicable diseases, and global health agendas. Over the past three decades we have witnessed how AIDS has become an integral part of health and development challenges for countries, yet many health services in low- and middle-income countries are still organized around the acute infectious disease episode model of care. The time is right to explore ways in which HIV scale-up may be leveraged to strengthen not only quality services during specific periods of life, such as pregnancy and childhood, but responses to a range of other chronic diseases by informing, enhancing, and energizing the systems required to provide continuity care for the millions in need.
In June 2011, we will have an historic opportunity to build on and better the performance of the past three decades. The promises world leaders will make, and words they will speak, will define the decade ahead: the decade that I believe will signal the beginning of the end of AIDS.