Time to Tip the Scales in Favor of Ending AIDS

Epidemiological modeling tells us that if we wait, the possibility of tipping the scales recedes -- and the price tag for the AIDS response climbs. But if we act, now, with a surge of investment, then the price of the AIDS response will go down over time.
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UNAIDS announced this week that the annual number of new HIV infections worldwide has fallen by one-third since 2001. This welcome news is evidence that the past decade of sustained global attention and funding for HIV prevention and treatment has had a real impact.

A decade ago, the notion of beginning to end the epidemic was a dream. Now it has the possibility of becoming a reality. But this can only happen with sustained and increased investment. Without this, the success to date will be lost and the price tag for the AIDS response will continue to climb.

The most urgent task for donors, national governments and policy makers committed to an effective AIDS response is to focus human and financial resources on delivering high-impact, evidence-based HIV prevention and treatment at scale -- reaching coverage for maximum impact. Doing a little of what works well won't achieve the goal. The next stage of the fight against AIDS depends on doing the things that work now as well as possible, so that they reach everyone in need.

While the new UNAIDS report documents declines in new HIV infections, 2.3 million people around the world still became infected with HIV in 2012 alone. We have yet to reach a global tipping point -- at which the number of HIV positive people starting treatment annually finally exceeds the number of new infections. The tipping point is an interim goal -- long-term success depends on many other interventions being rolled out successfully -- but it is a critical and attainable milestone.

Timing is everything. We can't get to the tipping point in a country or at a global level by moving slowly. Epidemiological modeling tells us that if we wait, the possibility of tipping the scales recedes -- and the price tag for the AIDS response climbs. But if we act, now, with a surge of investment, then the price of the AIDS response will go down over time.

A year ago, our two organizations, amfAR and AVAC, presented a "global business plan" for ending AIDS, identifying essential actions that would allow the world to reach the tipping point by 2014. Earlier this week we issued a progress report showing that while some critical gains have been made, the global tipping point is still years away. Business as usual is not going to be enough. We need to work faster, and we need to work smarter.

To keep the world moving toward the tipping point and the end of AIDS, here's what needs to happen now:

Sustain and increase investment
Global funding for HIV programs increased dramatically between 2002 and 2008, enabling the scale-up of treatment and prevention programs that have successfully slowed the growth of the epidemic. But then funding growth stalled. A new report from the Kaiser Family Foundation and UNAIDS shows that donor funding for HIV/AIDS has remained flat for the past five years. Recent and proposed cuts to the U.S. PEPFAR program further jeopardize future progress, and emerging economies (like Brazil, China, and Russia) have not yet made substantial investments in the global AIDS response.

As long as the epidemic continues to grow, the response becomes increasingly expensive - all the more incentive to invest today; good for public health and a sound financial investment. The upcoming round of pledges to replenish the Global Fund to Fight AIDS, TB and Malaria, which will determine levels of HIV funding available to developing countries over the next three years, provides an important opportunity for all countries to recommit to building the bridge to an AIDS-free generation.

Get focused
We don't just need to invest more; we need to make smarter investments. Resources should be focused on a core set of proven HIV prevention interventions, including antiretroviral therapy for HIV infection, services to prevent mother-to-child transmission, voluntary medical male circumcision programs, HIV testing efforts and comprehensive harm reduction for people who inject drugs.

And we need to do more to ensure that these services reach the people who need them most. Marginalized groups like gay men and other men who have sex with men, people who inject drugs, sex workers, and transgender people represent a growing share of new infections in every part of the world. Yet in too many places HIV prevention and treatment programs overlook, ignore, and exclude these populations. Further progress will be limited until we focus our efforts among those most vulnerable to infection.

Invest in research
The interim success reported last week is based on years of essential investments in science and research. Ultimate success depends on sustained investment in new approaches and technologies to accelerate the AIDS response. We need more prevention and treatment options, and we need to improve our understanding of how best to use the tools we have today. We need to invest in a true "implementation science" agenda that can help us deliver efficacious products on a broad scale and to all populations in need. But we all must sustain support for efforts to find an effective HIV vaccine and a cure for HIV -- the ultimate "ending AIDS" tools.

After many years in which HIV spread nearly unchecked, a remarkable global effort over the past decade has slowed down the pace of new infections and saved millions of lives. And that was with just the handful of prevention strategies we had available then.

Now we have many more options and growing knowledge of how to make different interventions work. To reach the tipping point that will speed us toward the end of AIDS, we need to strategically focus all the resources at our disposal to reach the right people in the right places with the right interventions, as quickly as possible.

Chris Collins is Vice President and Director, Public Policy of amfAR, The Foundation for AIDS Research, and Mitchell Warren is the Executive Director of AVAC, a global HIV prevention advocacy organization. The joint report - An Action Agenda to End AIDS: Where are we in realizing the promise of beginning to end AIDS? - is available at www.endingaids.org.

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