Great Strides in the AIDS Response -- and a Need to Continue Moving Forward Together

Once again, we are at a crossroads in the global AIDS response. Far from giving up or turning back, this is the time to learn from our experience, roll up our sleeves, and get the job done.
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By Amb. Eric Goosby, Michel Kazatchkine, Jeffrey D. Sachs, Dr. Aaron Motsoaledi, Michel Sidibé, and Tachi Yamada, M.D.

Six months ago, a girl named Agnes in the remote village of Pampaida in Nigeria was born free of HIV despite the fact her mother was HIV-positive. This happened because her mother sought prenatal care, and an alert health worker in her community health system was there to provide HIV testing and counseling services. Across the continent in Uganda, a woman named Princess is now 20 years old and healthy, despite living with HIV since birth, thanks to access to antiretroviral therapy. Once again, her family and community deserve the primary credit.

Yet others, far from Nigeria and Uganda, stepped up as well. The people of many countries have played a key part in these stories. Agnes and Princess are among the tens of millions of lives that have been transformed because of the collective AIDS effort of communities, governments, and civil society organizations.

The global AIDS response over the past decade is one of the greatest public health achievements in history. A few years ago, most people thought what has now been done was impossible. In truth, the AIDS response has always been characterized by a can-do spirit, defying perceived limitations, beating the odds and finding a way forward.

Once again, we are at a crossroads in the global AIDS response. Far from giving up or turning back, this is the time to learn from our experience, roll up our sleeves, and get the job done.

Millions of lives have been saved by HIV interventions since antiretroviral therapy has been made available. Around 67,000 children were born free of HIV in 2008 as a result of programs to prevent mother-to-child transmission. About 17% fewer new HIV infections occurred in 2008 than in 2001. Today, nearly 80% of all people who need HIV treatment in countries as diverse as Swaziland, Botswana, Philippines, Namibia, Thailand, Cambodia, Laos, and Russia are being provided life-saving medicines. And life expectancy in the most severely-affected countries is expected to rise over the next decade after sharply falling at the height of the AIDS epidemic. Uganda nearly doubled the number of people on treatment from 100,000 to 200,000 in just the last two years. Globally, between 2003 and 2008, treatment scale-up has grown ten-fold in low- and -middle income countries.

Encouragingly, some of the most affected countries are taking the lead. Today South Africa has the world's largest treatment program with about 1 million people, nearly one-fifth of the more than 5 million people on treatment worldwide. To meet its continuing need, it has boosted its domestic budget by 33% in one year to US$ 1 billion. Poorer countries such as Lesotho have doubled public spending on AIDS in the last two years. We expect to see countries such as China become full development partners before long.

We are building on this progress and charting a course forward.

First, we are improving the efficiency of the AIDS response, delivering needed services at lower costs while maintaining quality. We are now aggressively rationalizing costs and reducing waste. We are streamlining and simplifying treatment, shifting appropriate tasks from doctors to nurses and community health workers. Taking advantage of economies of scale, we are expanding the capacity of successful sites, and continuing to drive down costs per person served. South Africa recently revised its drug procurement policy, creating savings that will allow the country to provide treatment to many more.

Second, we are pushing for innovation to stretch our funds as far as possible while improving quality. New health information tools to manage the time of doctors and nurses have begun to make a measurable difference in the field. The world urgently needs a new regimen of drugs that are cheaper and more effective. We are partnering with the private sector, including both businesses and foundations, to learn from their core competencies.

Third, we are building on successes in HIV prevention -- by preventing new infections, we avert future costs of treatment and care. By focusing HIV prevention efforts where they are needed most, we maximize the impact of our investments. Mother-to-child transmission has been virtually eliminated in the US and Europe, and Botswana has shown that we can do so worldwide. In Kenya's Nyanza province, a province-wide male circumcision campaign is now under way, promising immediate and long-term prevention benefits for men and their partners. And South Africa has seen dramatic reductions in sexual transmission in recent years.

Fourth, rather than pitting one disease against another, we must recognize the reality that effective AIDS responses help us move farther and faster in addressing other health and development challenges. In Africa, we cannot make progress on maternal and child health without a robust AIDS response; neither can we make sustained progress on AIDS without also addressing maternal and child health. AIDS remains the world's leading cause of death for women aged 15-44; when an HIV program supports an HIV-positive woman in safe delivery of a healthy baby, we promote safe motherhood, child health, and a platform for basic health services in a community. Our investments in AIDS can be leveraged to enable us to meet the health challenges addressed by the Millennium Development Goals.

Finally, the AIDS response is a shared, global responsibility. But the challenge cannot be met by one donor alone, nor by donors alone. Success will require all donors to fulfill their commitments to universal access. It will require all partner governments in African countries to fulfill their commitments under the Abuja Declaration to spend at least 15% of their budgets on health. It will require the private sector in every country to play their part in country responses. And it will require the active participation of individuals, families, and communities everywhere.

We are well on our way to breaking the trajectory of the epidemic -- millions alive today bear witness to this. Working together, we can rise to meet this challenge.

Ambassador Eric Goosby is U.S. Global AIDS Coordinator for the U.S. Department of State.

Professor Michel Kazatchkine is Executive Director of The Global Fund to Fight AIDS, Tuberculosis and Malaria.

Professor Jeffrey D Sachs is Director of the Earth Institute at Columbia University.

Dr. Aaron Motsoaledi is South Africa's Minister of Health

Michel Sidibé is Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS)

Tachi Yamada, MD is President of the Bill & Melinda Gates Foundation's Global Health Program

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