#InDevelopment: The fight against AIDS - progress to be proud of and the path still to travel
In July our #InDevelopment blog series is marking the International AIDS Conference 2016 – this year’s theme is Access Equity Rights Now. Our experts will explore a number of pertinent themes. The conference, being held in Durban, South Africa, is the premier gathering for those working in the field of HIV, as well as policy makers, persons living with HIV and other individuals committed to ending the pandemic. In our first blog Farley Cleghorn, Palladium’s Global Director of Health, discusses ‘The fight against AIDS – progress to be proud of and the path still to travel’.
On the eve of the opening of the 2016 International AIDS Conference in Durban, South Africa, we can take stock of global progress against the disease and count many triumphs. The theme of the conference is Access Equity Rights Now and is meant to encapsulate the intersecting needs of broadening the effective response to deliver effective and competent services to the majority of people who need prevention and treatment. It is significant that the conference is being held in Durban, South Africa, the country with the largest HIV epidemic and the largest AIDS treatment programme in the world.
However, there are still many policy and programmatic impediments that hold back an optimal response at the individual, country and international levels. With the vast majority of countries committed to UNAIDS guidance of 90-90-90, additional effort is being poured into achieving this commitment and mitigating barriers to a comprehensive and joined up set of actions everywhere.
90-90-90 is an ambitious treatment target to help end the AIDS epidemic. By 2020, 90% of all people living with HIV will know their HIV status. By 2020, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy. By 2020, 90% of all people receiving antiretroviral therapy will have viral suppression.
In reflecting on our progress towards this commitment, some common themes emerge:
Access to Treatment has never been better and outcomes are great when treatment is maintained. Costs are coming down.
- This global reality masks big inequities depending on where you live. Quality can vary significantly and confidential access to HIV testing is variable.
- Much effort is going into understanding and plugging leaks in the treatment cascade.
- Prevention of mother to child transmission is enjoying huge successes in many parts of the world and some countries have eliminated such infections.
- Adolescents are being recognized as a distinct population in many countries and their unique needs are being better understood.
- While costs have come down, total need is increasing so more has to be done with less money. Programs are seeking efficiencies wherever they can find them in order to increase targets and impact.
Access to appropriate and effective HIV prevention services is still at very low levels in many places and in many vulnerable populations. For example, in a report published in the Lancet July 9th, we see that Gay, bisexual and other men who have sex with men continue to have disproportionately high burdens of HIV infection in countries of low, middle and high income around the world.
- There is still enormous need for policy reform, funding and improvement in effective HIV prevention and treatment services, including expanded access to pre-exposure prophylaxis (PrEP) which has been highly effective in dramatically reducing transmission among gay and bisexual men and transgender women.
- The same applies to people who inject drugs in Eastern Europe and other parts of the world, who are criminalized and cut off from appropriate medical services.
- Stigma and discrimination continue to play an outsize role in these epidemics. In many countries, these members of vulnerable groups are just not welcome in health clinics and the fear of discrimination stands in the way of necessary services,
- We are still a long way from evidence-based prevention in many countries.
- Adopting the cascade approach to prevention in a similar way to how we approach treatment may represent an advance as is the bundling of prevention services or combination prevention.
Palladium at #AIDS2016
Palladium’s delegation to the International AIDS Conference 2016 will be led by Ron MacInnis and Sara Bowsky. Through the Health Policy Plus project we will co-sponsor a satellite session – Listen Up!: What Youth Living with HIV Need to Achieve 90-90-90 – on optimal adolescent treatment. Palladium will also deliver many original papers on health financing, resource mobilization and allocation, stigma and discrimination, sexual minorities, voluntary medical male circumcision, community engagement and prevention.
InDevelopment is Palladium’s blog series exploring emerging, cutting-edge and profound themes in global development. You’ll hear from our global experts and guests every two weeks. For more from Palladium’s International Development work follow us on Twitter, LinkedIn, Facebook and at #InDevelopment.
About the author
Dr. Farley R. Cleghorn, M.D., MPH serves as Global Director of Health at Palladium. He has 20 years of HIV/AIDS research and programmatic experience in the Caribbean and the developing world, where his focus has been on the epidemiology, natural history, and pathogenesis of HIV/AIDS and related infections. He has made many original contributions to the field of human retrovirology, particularly in the areas of HTLV-I epidemiology and the modeling of HTLV-I oncogenesis (a model for cancer causation), as well as the epidemiology and natural history of HIV-1 infection.