What a Difference a Decade Makes

For the first time in many years, a new message is on the lips of the people on the frontlines -- together, we will end AIDS.
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In an election year, party conventions bring together the hopeful, the courageous and the visionaries as they seek to secure the future. This week in Washington D.C., a different kind of convention is taking place, one that has not taken place for nearly 20 years in the United States, bringing together thousands of delegates from every corner of the AIDS response.

For the first time in many years, a new message is on the lips of the people on the frontlines -- together, we will end AIDS. Just a decade ago, this very thought would have been dismissed. What has changed? Where has this hope come from?

It comes from the resilience and steadfastness of the global community, led by people living with HIV, grandmothers, sisters, brothers, mothers, doctors, nurses, scientists, activists to halt the AIDS epidemic from defining our lives.

This is our story.

One: results. There were 100,000 fewer new HIV infections in world last year. The year before, another 100,000, and the year before that, another 100,000. Year after year, country by country, city by city, village by village, communities are working hard to stop new HIV infections.

Access to lifesaving antiretroviral treatment has come a long way -- a record 8 million people were on antiretroviral therapy at the end of 2011, far, far above the 300,000 lucky ones just a decade ago. Just like new HIV infections, year after year, fewer people are dying of AIDS.

Just 12 months ago, world leaders, led by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United States' President's Emergency Fund for AIDS (PEPFAR), agreed to a global plan to eliminate new HIV infections among children. In 15 of the 22 countries, where 90 percent of new HIV infections among children occur, new HIV infections have dropped by 20 percent since 2009. From now on, programmes focus on not just on keeping the children free from HIV, but also ensuring that their mothers have access to lifesaving treatment for their own health.

Two: investments. A decade ago, the total investments for AIDS was around U.S. $500 million. The prevailing wisdom at the time was that spending on AIDS is a bottomless pit, a recurring expense with little hope of any returns. At best, AIDS investments were seen as charity. Pressure from activists, since the first day the disease was reported some 30 years ago, forced world leaders to accept that AIDS could be controlled and urgent action was necessary. The creation of the Global Fund to fight AIDS, Tuberculosis and Malaria and PEPFAR spurred more concerted action on the ground.

Today the world invests more than U.S. $16.8 billion on AIDS annually. As real dollars reached villages and communities, human resilience that was until then the vanguard of care and support for the dying, turned into a movement of saving lives. Girls went back to school and food was back on the table as parents got back their jobs, and people returned to till the land. The vision of unsupervised orphans turning into uncontrolled militia and becoming a threat to international security has since been transformed into one where these very children, now young people, are taking over the leadership of the AIDS response and we are following their lead.

The lead of the United States and the international community is now being enjoined by all countries. In the last five years 81 countries have increased their domestic investments by more than 50 percent. Domestic investments have surpassed global giving in 2011. Low- and middle-income countries invested U.S. $8.6 billion in 2011. The BRICS countries (Brazil, Russia, China, India and South Africa) are increasingly taking ownership -- more than 75 percent of the resources for AIDS come from domestic sources.

While countries are tipping the balance, international assistance still remains critical and indispensable in the short- and medium-term. In sub-Saharan Africa, investments from public sources increased by more than 97 percent, but international assistance still accounted for two-thirds of investments for AIDS. Increase in domestic investments cannot become an excuse for international partners to reduce or simply maintain the current level of investments.

Three: science. When governments and communities face the reality head-on and put to work programmes that are based on science -- not ideology or tradition. Last year, I was humbled by the elders of the Luo tribe in Kenya. They broke with an age-old tradition and sanctioned male circumcision for their boys and men, to protect them from HIV infections. Hundreds of thousands of men have voluntarily undergone medical male circumcision since then. There millions more who can benefit.

China, which for many years resisted action on AIDS and had a punitive approach to controlling individual drug use, embraced scientific evidence and scaled up access to methadone substation programmes, not just saving public resources, but also providing drug users with dignity and respect and a chance to manage their lives. Sadly, many countries still do not provide harm reduction services to people who use drugs.

Today antiretroviral therapy provides triple action, saving the life of the person living with HIV, stopping HIV transmission to their sexual partner and to their children. We have to make the most of this opportunity. We have a global target of providing 15 million people with HIV treatment by 2015. We can do that, and we must be better it. Every person who wants antiretroviral therapy, for their own health or for protecting their loved ones, must have unqualified access to HIV treatment.

An AIDS vaccine is feasible, we have learnt. A microbicide can empower women to initiate and control HIV. Pre-exposure prophylaxis can provide new options for people without HIV to protect themselves. Condoms still work -- are efficient and cost-effective and have few side effects. The quest for a cure is now beginning to take shape. Science is working for people.

Four: rights. When fear of the virus turns into fear of people, societies crumble. And when rights of the people are protected, societies become engines of growth. Bad laws have provided sanctuary to the virus and it must end. Recently, the United States passed legislation to allow people living with HIV to enter the country. Next week's conference is a celebration of that move, as the global community previously refused to hold the global AIDS conference in the country as its laws discriminated people living with HIV, even when the United States was the biggest single contributor to the AIDS response.

Even as we say a big THANK YOU, we cannot accept unjust laws, wherever they are and whoever makes them. Take for example, bilateral free trade agreements. Many of these agreements seek to undermine the Doha Declaration that seeks to provide access to lifesaving medicines to all, alongside protecting intellectual property. Using the flexibilities provided under the TRIPS agreement, many countries have been able to bring HIV treatment to their people. These gains must be protected.

Many countries have decriminalized consensual adult sexual behaviour, restoring dignity to men who have sex with men and transgender people. From Delhi to Cape Town, courts and legislators have corrected a wrong measure that was handed down from the colonial times. But far too many countries are still clinging to these archaic laws -- even when the original authors have long since moved on. Sex workers, people who use drugs, men who have sex with men, and people living with HIV are forced to remain underground and are not able to come forward and use the prevention and treatment programmes that are available, as they fear stigma and discrimination. Yet when they are empowered, they can self-manage and lead their own programmes.

Five: people. Above all, it is people who have changed the face of the AIDS epidemic. This week, thousands of them are in Washington, D.C., and we honor and salute them. But they are not the only ones, tens of thousands more are silently working behind the scenes. The results we celebrate are theirs.

Last month I met with Mike Shriver, former special advisor to the mayor of San Francisco, who has been living with HIV for the last 25 years. One of the pioneers of the AIDS movement, he symbolises hope as well as the distance the world has travelled. People like Mike, their early struggles and their vision inspires me.

They have been brave -- taking to the streets, demanding their rights and at the same time forging alliances with doctors and scientists, beginning conversations with pastors and enforcement officials, disclosing their HIV statuses to their families and holding the hands of the people dying. It is because of people like Mike that I think that we can get to zero. We can end AIDS. We will end AIDS.

What a difference a decade makes. What a difference people make. Let the XIX International AIDS
be known as the beginning of the end of AIDS.

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