AIDS Response at Crossroads: World AIDS Day 2013

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This year’s World AIDS Day will not just be a string of events the world community observes every year on December 1st, reiterating our resolve to combat the pandemic. This year, it will occur at a defining moment in the global response when all stakeholders are standing at crossroads, looking to where we should head.

There is celebration, sometimes excessive, about the successes achieved since 2001 when the rules of engagement with HIV/AIDS changed from appeasement to aggressive combat, denial to ownership, and condemnation to meaningful participation by communities infected and affected by the epidemic. The resource base for AIDS programmes moved to billions, and affordable generic medicines have been made available, saving the lives of 10 million people. New infections have made an appreciable decline of 33% in the Ground Zero of the epidemic, sub-Saharan Africa. Most important, there has been an aggressive breakthrough in reducing the number of children born with HIV, and the target of zero new infections among children by 2015 appears feasible.

Encouraged by this impressive progress, world leaders have started talking about an AIDS-free society as an achievable goal in a finite time frame. Secretary-General United Nations has spoken on more than one occasion about the emergence of an AIDS-free world. The UN Joint Programme on AIDS (UNAIDS) has adopted the achievement of three zeroes as a global strategy. A new Commission established jointly by UNAIDS and Lancet has ‘what will it take to end AIDS’ as one of its three overarching objectives.

An outsider who is not familiar with the history of the epidemic can be led to believe that success is on hand and an AIDS-free world is just round the corner. This is the pitfall in crying victory too early when there are many challenges lying ahead, including sustainable financing and political support for AIDS programmes. While new infections are on decline in Africa and Asia-Pacific, they are still on rise in Eastern Europe, Middle East and Northern Africa. Another 5 million more people are in need of treatment, and this number will increase further with the new WHO guidelines on treatment. The biggest obstacle is however the adverse legal environment surrounding the people living with HIV and key affected populations. Progress on decriminalising these behaviours has been extremely slow and in some countries negative.

Resource availability for AIDS programmes has been impressive until now, but it is uncertain whether countries will commit matching domestic resources to cover the gap left by withdrawal of donors from AIDS financing. Evidence shows that external financing has funded prevention programmes focussing on vulnerable key populations. These communities are apprehensive about whether countries would continue with this prioritisation once the external funds are withdrawn. And for political leaders at country level, AIDS is no more a challenge. By providing treatment services to infected populations and preventing them from dying, they feel they have won the battle.

The added challenge on this World AIDS Day is the ongoing global dialogue on defining the post-2015 development agenda for the next 15 years. In the next year, world leaders will be actively negotiating various components of a new development regime where priority will be accorded to issues like environment and sustainable development. There is overall concern whether health and HIV will get the right priority in the post-2015 agenda. As this will evolve through an intergovernmental process in the UN General Assembly, much depends on what priority country leadership, especially non-health actors, will accord to AIDS and whether emergence of an AIDS-free society would be considered by them as an achievable goal.

On this World AIDS Day, we need to be vigilant and work closely with country leadership and UNAIDS to ensure that AIDS is not dropped just at a time when the battle is half won.

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The author of this post, J.V.R. Prasada Rao, is UN Secretary-General’s Special Envoy for AIDS in Asia and the Pacific and serves as chair on the board of India HIV/AIDS Alliance.

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