When 25 Million Africans Were Sentenced to Die

Preventing the next pandemic was the topic of Dr. Jim Kim's talk at the Washington-based Center for Strategic and International Studies last week, but if his solution was the only takeaway message audience members heard they weren't paying attention. Dr. Kim is a bonafide global health hero who for the time being is also President of the World Bank Group.

He packed a lot in his presentation, but a key message was his timely reminder that "we are still working with mental models that hamper our ability to have higher aspirations." No one is exempt, even the brightest people with the best of intentions have blind spots that obstruct their ability to see past their preconceived notions.

His message is especially poignant arriving just before the 35th Anniversary of the U.S. Centers for Disease Control and Prevention's alert of the arrival of what would be as AIDS and a few days away from the opening of the 2016 High-Level Meeting on Ending AIDS in New York City.

Some of us in the audience rallied to the World Health Organization and Dr. Kim's then radical call of the "3x5 Initiative" to demand treatment for a paltry three million of the millions who were living with the HIV at the time. He told the story to those too young to remember that as shocking as it now seems, the conventional wisdom at the time was that 25 million Africans had to die. All sorts of short-sighted reasons were supplied, but they all pointed to the conclusion that providing AIDS treatment was just impossible.

Thankfully far fewer of our worst fears at the time came true. We would not be having the serious discussions about ending AIDS by 2030 that will take place this week were it not for the champions whose compassion, courage, perseverance and action brought us to where we are today. The path from the groundbreaking LIFE initiative that first boosted US support for global AIDS programs to $100 million during Bill Clinton's administration to the billions available to the President's Emergency Plan for AIDS Relief established by George W. Bush is littered with skeptics proven wrong.

The success in making so much progress against the global AIDS pandemic isn't due to American efforts alone, but there is no mistaking as President Obama said recently that "American ingenuity and leadership has shaped the world's response to this crisis."

When governments officials, international organizations, the medical and scientific experts, AIDS practitioners, human rights defenders, communities most affected and at risk, activists and advocates of all types convene in New York, the conversation is likely to converge on several key topics.

Pay now or pay far more later. International and domestic investments for HIV programs in low and middle-income countries have to rise by $7 billion by 2020 to establish the momentum needed to reach the 2030 targets, according to UNAIDS estimates. Slacking off and accepting the status quo will result in an additional 17.6 million HIV infections globally and an additional 10.8 million AIDS-related deaths globally between 2016 and 2030.

Bigotry and hatred kill. A report prepared for the High-level meeting cites a survey finding that one of every eight people living with HIV report has been denied health care because of their status. The UNAIDS World AIDS Day 2015 report found that in 35% of countries with available data, over 50% of men and women harbor discriminatory attitudes towards people living with HIV Prejudice. Negative attitudes and abuse directed at people living with HIV and AIDS are bad enough, but the resulting stigma also discourages people from knowing their HIV status and seeking lifesaving treatment.

Treatment works. The conventional wisdom of 15 years ago was dead wrong. Not only has expanded treatment produced a 42% decline in AIDS from 2004 to 2014, but the sharpest reductions in new HIV infections have occurred in countries where treatment was scaled up the fastest. UNAIDS reports there are direct correlations between improved access to HIV treatment and reductions in HIV-related stigma and discrimination. But the job is far from finished, as of 2014; 17.1 million people living with HIV did not know their HIV status.

Prevention is enormously important, especially when 70% of women and 65% of men do not have basic awareness about HIV. Engaging and mobilizing the community is a vital part of filling the knowledge gap. A good example has been the teamwork of Nigerian unions, employers, and the International Labor Organization which has resulted in huge gains in expanded HIV testing and access to treatment.

Dr. Kim's speech invoked memories of a long path of trailblazing progress that was only possible because a few people dared to challenge the conventional wisdom. The global AIDS response is far from over, but if we see it through it will be a remarkable achievement. We have other unfinished business, and that is to share our hard earned lessons with advocates and activists tackling other enormous global challenges. Certainly one of those lessons is to encourage activists to dare to be audacious and unrelenting, especially when someone tells you that people just have to die.