By Michel Sidibé, Special to CNN
Michel Sidibé is executive director of the Joint United Nations Program on HIV/AIDS (UNAIDS). He is attending the 19th International AIDS Conference taking place in Washington D.C. this week. The views expressed are his own.
Getting to zero – zero new HIV infections, zero discrimination and zero AIDS-related deaths – was unimaginable just a decade ago. Today, it has moved from commitment to action – from President Obama to Ebube Sylvia Taylor, born free of HIV despite her mother being infected with AIDS – to make AIDS part of history. The challenge before us is not how, but how quickly. We owe it to the more than 34 million people living with HIV.
The rate of new HIV infections has fallen in most parts of the world – more than 56 countries have stabilized or reduced HIV infections by more than 25 percent. The results are most dramatic in sub-Saharan Africa, where the epidemic has had its most devastating impact. In Africa, AIDS-related deaths have reduced by more than 31 percent as a record number of people are on antiretroviral therapy, more than 6 million people.
For the first time in the history of AIDS, the number of people taking the lifesaving antiretroviral drugs exceeds the number of eligible and waiting. Young people have taken charge of their destiny. In 22 countries, the rate of HIV infections among young people has fallen by more than 25 percent in the last decade. Fewer children are being born with HIV. A major push by UNAIDS and the United States PEPFAR program has seen a dramatic drop in new HIV infections among children – 100 000 fewer new HIV infections in just two years.
The global AIDS response has benefited from the generosity of the people of the United States – the world owes American citizens a big thank you. Three out of five dollars invested in AIDS internationally come from the United States.
Now for the first time, buoyed by the successes in the response, 81 countries have increased their share of contributions to national AIDS programs by more than 50 percent in the last five years. In sub-Saharan Africa, investments grew by 97 percent. South Africa has led the challenge by quadrupling its investments, now reaching nearly $2 billion annually, the highest for any low- and middle-income country. Russia, Brazil, China and India also are stepping up and taking responsibility for their AIDS response from domestic revenues. Zimbabwe’s AIDS levy generated nearly $26 million last year. This is global burden sharing in practice.
But the world still faces a $7 billion gap annually. The United States can do more and so should the rest of the world. Investments for AIDS has to be predictable. Too often in the response to this disease, we operate “hand-to-mouth”. That’s why sustainable solutions are so important. We have to shake day-to-day dependency and create sustainable solutions for the AIDS response. The number of pills and condoms available shouldn’t depend on the volatility of the financial markets or charity.
The way we work has brought us here, but to get to zero we have to change tracks. What worked 10 years ago, 5 years ago isn’t working today. The world has changed and so must we.
This week, more than 20 000 delegates will come to Washington, D.C. to participate in the 19th International AIDS Conference. I hope to begin a conversation in shaping the agenda for securing the future – what UNAIDS calls the “AIDS+ agenda.”
There are five cornerstones for this agenda:
The first one is to secure the science. There can’t be two different sets of prescriptions for the same disease – one for the rich and one for the poor. Access to the best possible medicines must be guaranteed and the lack of resources or capacity must not be an excuse. In addition, there’s a lot of room for innovation – in producing simpler ways to manage HIV treatment. These innovations must be robust enough to work everywhere in the world, from a remote village in Cambodia to the United States. Last week, we laid out a new blueprint to find a cure for AIDS. The quest for a vaccine, too, has taken one-step forward. Science will eventually deliver a final blow to AIDS. Meanwhile, let us do what is in within our control.
The second is to secure good laws. There’s no reason why countries should stop people living with HIV from moving freely. There’s no reason for the criminalization of adult sexual behavior or punitive laws against people who use drugs, sell sex or are living with HIV. Women and girls must feel safe and able to protect themselves from violence and abuse.
When there’s zero discrimination, it will become easier for people to access essential HIV services. Securing access to services is the third cornerstone. The presence or absence of a virus in the human body should not determine if people have access to affordable health care, health insurance, access to schools, adequate nutrition and social protection.
The fourth is securing the full investment. World leaders have agreed to invest between $ 22 billion to $24 billion in low- and middle-income countries annually by 2015. The AIDS response has to be fully funded. Halfhearted and half-empty promises don’t deliver results. Building half a road won’t get you to your destination. If you don’t invest fully, you’ll have to pay more later and pay forever. We also have a responsibility to invest efficiently and effectively. Far too many countries invest in programs that are either ineffective or efficient. We have to focus on where the next 1,000 infections will occur, not on pet projects. Ideology has to be replaced by evidence. People have to take precedence over politics.
The fifth cornerstone is community ownership and global solidarity. It’s been proven again and again that when communities are empowered to design and manage their own programs, not only do costs come down, but results are guaranteed. From sex workers in Kolkata to people who use drugs in Kiev, mentor mothers living with HIV in Maseru to men who have sex with men in Dakar, they have managed to provide support to their peers and provided a safe place to access services with dignity and respect. However, they can only do their jobs if we continue to build and maintain global solidarity.
Last summer, world leaders agreed to a set of global targets to be achieved by 2015. These have to be met, but we need to look beyond. We have to aim for the end of AIDS – and that begins today.