Ambition is what drives us all. It's the belief that through commitment, hard work, the right motivation, and bold goals, we can accomplish something as substantial as the eradication of a disease.
Too often though, we fall victim to the limitations we place on our ambitions - we segment our efforts, or believe that we shouldn't set our sights too high for risk of failure.
UNAIDS recently released its annual World AIDS Day Report, and the data and findings in this report have left many people scratching their heads in confusion.
Tuberculosis (TB) is still the number one killer of people with HIV, and yet this report has completely failed to even mention TB in its "Fast-Track" strategy for ending the AIDS epidemic by 2030. A major reason behind this gap is persistent resistance to the integration of HIV and TB health services, and a general ignorance of the notion that patients should be tested and treated for both infections at the same time, and in the same facility.
As evidenced in the scorecard included in the UNAIDS report, most countries are falling way behind the World Health Organization (WHO) guidelines for service integration, meaning that patients are forced to visit different facilities and risk only being treated for one disease or the other. In fact, the highest ranking in this scorecard, indicates only a minimum of 50% coverage - if only half of the people in a country who are infected with both HIV and TB are receiving treatment for both diseases, that is a colossal failure, not reason for celebration.
So why is the shortfall so enormous? The WHO recommendations outlining a streamlined, fully integrated approach to treating TB and HIV together were first published in 2004, and yet, as explained in a recent report by ACTION, "WHO recommendations on TB-HIV collaborative activities have not been embraced equally across donors and implementing countries, and [...] those interventions are under-resourced and under-prioritized, especially by HIV programs."
While HIV-focused health facilities and programs cannot shoulder all of the blame for this gap, it would appear that there is a lack of urgency and ambition to address HIV co-infections that is coming right from the proverbial top. The world looks to UNAIDS for guidance, support, and yes, ambition, in how we're going to end AIDS once and for all, and ignoring the important role that fatal co-infections play when setting long-term goals, is nothing but short-sighted.
As Canadians, we also look to our government for similar guidance, support, and ambition in the mechanisms that we fund, the policies that we implement, and the diversity of our approach. Canada continues to be one of the largest donors to The Global Fund to Fight AIDS, TB and Malaria, but there is no such thing as a one-stop-shop when we're trying to eradicate a disease. We cannot put all of our money in one single place, tie the purse strings shut, and just hope for the best. Canada has a proud history of supporting innovation through initiatives like TB REACH, a project of the Stop TB Partnership that exists to fund and promote new ideas, new methods, new ways of combatting TB, and bridging the divide between TB and HIV service delivery in high burden areas. TB REACH grantees often build upon existing successful models of HIV healthcare, to integrate TB testing and treatment alongside HIV to battle co-infection on the ground.
There is absolutely no way that we can 'Close the Gap' by being complacent in setting our targets. We must ask ourselves, when it comes to ending the AIDS epidemic, what does success look like? Does it mean putting the blinders on and telling ourselves that the status quo is still good enough? Or do we want to aim a bit higher, try something new, and risk failure in the pursuit of accomplishment? When lives are at stake, complacency is never good enough.
This blog is part of a World AIDS Day series produced by the Interagency Coalition on AIDS and Development (ICAD) in recognition of World AIDS Day (Dec 1). The series runs from Dec. 1-7, 2014 and will feature a selection of blogs written by our member and partner organizations. Each article will delve into a specific issue, highlight different challenges and offer diverse perspectives and insight on what must be done to Close the Gap. Disclaimer: The views and opinions expressed in this blog series are those of the authors and do not necessarily reflect those of ICAD."
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