We look back at the last 30 years of AIDS, so that we can shape the future of the response. About 65 million people have been infected by HIV (human immunodeficiency virus) since it was first reported – and nearly 30 million people have lost their lives to it. Global reaction was slow at first. Then in 2001 world leaders signed the Declaration of Commitment on AIDS at the United Nations. The intervening years have seen goals set, breakthroughs announced, and progress made. In 2006, countries committed to reaching goals towards universal access to HIV prevention, treatment, care and support – today more than 6.5 million people are alive thanks to access to antiretroviral therapy. Investments for AIDS have increased by more than 900 percent since 2001. Prevention is working, with a 25 percent drop in the rate of new HIV infections. The news has gotten better and better. New HIV prevention options such as Treatment for Prevention, CAPRISA gel – a female controlled microbicide – and iPreX – a pre-exposure prophylaxis – have emerged, adding hope to people who want to protect themselves and their loved ones from the virus. Firmly held ideologies have in many places been replaced with compassion and doors have opened for dialogue. Evidence is being embraced by political leaders when making policy decisions. It is no longer uncommon for activists, communities affected by HIV and policy makers to plan together, ironing out differences and exploring new frontiers. The global solidarity for the AIDS response has shown what humanity can achieve when they get together. We need more of the above, a lot more. Today, the AIDS response is bursting at the seams. The demand for prevention and treatment is increasing. Opportunities abound – and we can seize them if we move on five fronts. First, embrace the benefits of Treatment for Prevention. People living with HIV can, for the first time, choose a method that is 96 percent effective and which they can initiate and manage with respect and confidence. Treatment for Prevention must be an option for all people living with HIV. But this should not have to come at the cost of the nine million people who are eligible and waiting for treatment for their immediate survival. Additional Treatment for Prevention must be made available. Second, pregnant women living with HIV need to have access to the best possible treatment regimen to protect themselves and their children. Some 31 countries still use sub-optimal regimens to prevent mother-to-child transmission of HIV. In high-income countries few children are born with HIV. There is no reason why it cannot be the same everywhere. The life of a child and a mother has the same value, irrespective of where she or he is born and lives. We can eliminate new HIV infections among children by 2015. Third, there has to be space for community dialogue and social transformation. Violence against women and girls, inter-generational sex, homophobia, gender inequity and criminalization of people living with HIV, people who inject drugs or sell sex must end. Without such transformation, HIV prevention measures will only be partially effective. This will require the leaders in village and urban communities and capitals to break the silence about these issues and act boldly, with conviction. Fourth, AIDS investments must be made in full. This should be through a new shared responsibility agenda, where every country, rich or poor, puts in its fair share – no exceptions, no excuses. A deferred investment today will have a multiplier effect on investment needs in the future – a prospect no finance minister will like to face. At the same time, the health community must accelerate innovation in diagnostics and treatment, reduce unit costs, increase efficiencies and invest in programmes that work so that there is more value for the money invested. Finally, the AIDS response has to integrate with broader health and development programmes. The AIDS response has to come out of isolation and become the catalyst for achieving the Millennium Development Goals related to health – especially reducing infant and maternal mortality as well tuberculosis. Health care delivery must not remain in silos. As world leaders gather at the United Nations to discuss the future of the AIDS response, they have an opportunity to act on these five frontiers and set clear targets and milestones for the next five years. The 34 million people living with HIV and their families deserve nothing less. Michel Sidibé is the Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS) and Under Secretary General of the United Nations.
