AIDS - It's not over

A series of articles by guest writers for World AIDS Day Part of AVERT's World AIDS Day 2012 campaign, ‘Reflections on the Epidemic’ are a series of articles by guest writers. Our guest writers range from global leaders, writers, experts, activists, physicians and people personally affected by HIV and AIDS; and they represent various countries, experiences and backgrounds from all over the world. We are grateful to all our guest writers for their effort and the diverse and insightful viewpoints that they contributed to the world’s response to HIV and AIDS. We will be re-featuring these articles over the next few weeks on a weekly basis. Browse through this week’s featured articles, and see the full list below.

In recent years, there has been some wishful thinking about the end of AIDS. It is true that we must be very ambitious in our goal to stop AIDS, and thanks to a sustained global effort over two decades, we have succeeded in stabilizing the pandemic, treating millions around the world - more than 8 million people in low- and middle-income countries now receive antiretroviral therapy. However, rumours of the demise of AIDS are greatly exaggerated.

Today, well over 30 million people are living with HIV globally, and nearly twice as many people are newly infected with HIV as are put on ART every year. With 2.7 million new infections and 1.8 AIDS-related deaths in 2010,¹ it is hard to claim that we have won the battle. Discrimination continues to be a brutal fact of life, particularly for the poor and marginalized. We need a response that is multi-sectoral and society-wide to change harmful behaviours, influence social and cultural attitudes and bring treatment to all those in need – a huge challenge for decades, if not generations, to come.

My experience since the early 1980s in Africa, and later at UNAIDS, taught me that it takes a lot of time, energy and effort to translate evidence into policy and policy into large scale action, and to build coalitions that actually get things done on the scale that is needed. You need governments, international agencies, funders, NGOs, researchers and health professionals to work together and act strategically. 

Strong national leadership at the highest level, with country-level commitments with concrete indicators and agreed targets, has been critical in achieving coordinated action. People living with HIV, along with campaigning and advocacy groups, continue to play a central role in raising the profile of HIV and AIDS, educating and mobilizing affected communities and holding governments and international organizations to account.

The problem right now is that international funding for HIV and AIDS programmes in low- and middle income countries is declining, unavoidably resulting in more deaths and more new infections. This perverse trend must be reversed, partly by affected countries themselves in terms of  “shared responsibility” to use the words of Michel Sidibé, the leader of UNAIDS. At the same time, we must create synergies with other health and social programmes in order to reach more people, reduce unit costs, and create better health outcomes. However, specific prevention and care programmes for marginalized populations such as men who have sex with men, sex workers and drug users will remain necessary as they are rarely welcome in mainstream health and social structures.

“we need optimism tempered with realism”

We must continue to rally the whole world in this effort, and this is why we need optimism tempered with realism. It might seem far-fetched to call for "Zero new HIV infections. Zero discrimination. Zero AIDS related deaths", but it is important to imagine what a world after AIDS might look like, and how we can attain it, even if we know it might take many more decades to do so.

As a global movement, we can look back with some pride over what has been achieved, the millions of lives that have been saved, and the suffering and stigma that have been relieved. We can also look forward with hope, as long as we don’t fool ourselves that we have somehow beaten AIDS, because it isn’t over by a long way.

Professor Baron Peter Piot is Director of the London School of Hygiene & Tropical Medicine and was formerly Under Secretary General of the United Nations and founding Executive Director of UNAIDS. His latest book ‘No Time to Lose: a life in pursuit of deadly viruses’, was published in summer 2012.

For further information on the global epidemic see AVERT's section.