30 years have passed since the Centre for Disease Control (CDC) published its first reported case of AIDS. Since then over 25 million people have died from AIDS and an estimated 33.3 million are living with HIV today. While tremendous advances have been made in terms of treatment, steering AIDS from what was once a fatal disease to a now chronic one; AIDS is still a global health threat, with many in the developing world unable to access adequate treatment. However, while dealing with the present challenge of HIV, the global community must also consider the challenges of the future. In a time of austerity one of the difficulties those in the HIV domain are facing is funding and it seems there may be no reprieve in the coming years. Such paucity of funding is not only an obstacle to programmes that decrease the spread of HIV and increase treatment, but also obstructs vital research across all disciplines that aid implementation and effectiveness. Professor Whiteside, Executive Director of HEARD (Health Economics and HIV/AIDS Research Division in South Africa) is an internationally esteemed health economist with over 25 years of experience in HIV and author of “AIDS in the 21st century” is cognizant of such issues. Whiteside believes the issue of funding is a fundamental and pressing concern: “The biggest problem we now face is getting the funding in place and managing a sustainable response” Explaining further: “The global economic climate means we have to do better with what we have while keeping the pressure for resources.” Such scarcity will certainly mean a greater need for efficiency and accountability called for by donors. However, another challenge that exists beyond financial ones includes the omnipresent and ubiquitous stigma faced by people who are HIV positive. Such stigma is not only hugely upsetting and isolating but also a practical challenge that prevents people from being counselled and tested for HIV. Speaking with Dr Chris Lemoh, an infectious disease consultant, researching HIV within African communities in Melbourne, Australia; the challenges are not to be taken lightly. “People are afraid, but need to be informed” he says with gravitas. He considers that “timely diagnosis of people who have acquired HIV but are unaware of their status” is pivotal. Furthermore, he believes that global leaders are not doing enough to prevent new infections and avoid practices that marginalize those at high risk. Explaining: “Hostile legal and political environments still marginalise those facing the highest risk of infection and having least access to prevention and treatment: MSM (men who have sex with men), IDU (Intravenous drug users), sex workers and migrants” “I cannot see the global political leadership allowing the social changes that redress current social and economic inequities driving new infections and preventing access to treatment and support”. In addition, some believe that there needs to be greater emphasis on community leadership and participation of communities. Dr Ian Campbell, director of AFFIRM, an initiative that facilitates local responses to HIV, is a vehement proponent of community responses. His opinion is that much of the “community engagement is tokenistic” and that the biggest challenge to preventing the spread of HIV is by not engaging with communities. Speaking with Campbell he says “we need to participate with people living with and affected by HIV…Fallback or default to centre based treatment is now again the norm- a product of thoughtless donor initiatives that may be genuinely intended but rely essentially of a ‘fix up' approach, as in the first decade of the HIV response” Campbell calls for a greater emphasis on HIV responses that are “placed in the hands of the people”. Such community driven responses and good leadership in HIV are reiterated by the AIDS 2031 consortium in their recently published book- ‘AIDS: Taking A long term view' which critically analyses what should be done “differently now to radically reduce the numbers of infections and deaths by 2031”. Moreover, what is evident is that although great progress has been made in terms of science and treatment, there are many challenges that need to be addressed, such as financial uncertainty, equity and leadership before the future of the ‘AIDS-free generation' which we all hope for, can be a reality. BM
