A full version of the special edition of Spotlight will be released during the International AIDS Conference in Durban which starts on 17 July. This is an article which will be published in Spotlight.

By – Anele Yawa

What is the state of play as the world returns to Durban 16 years after the historic 2000 AIDS conference? It is simple: less than half of people who need HIV treatment have access to it.

Around 17 million people living with HIV are receiving antiretroviral therapy, 20 million are not. We now know that 20 million people are at increased risk of developing tuberculosis and cancers – even if some of them still have high CD4 counts. We also know that providing those 20 million people with treatment will help prevent many new HIV infections.

It is clear what we need to do – we need to make sure an additional 20 million people have access to treatment. On this score most of the researchers, doctors, diplomats, policy-makers and activists gathering in Durban will agree. We have all the slogans and all the right rhetoric. We all agree that 90-90-90 is the way to go.

But 20 million? Twenty million when all we’ve achieved so far is 17 million – and that 17 million only through years of struggle, sweat and tears, with years of donor assistance, and unprecedented political will. Is it not madness to think we can get another 20 million on treatment? Is a reality check overdue?

If we are ever to get near an additional 20 million, then Durban has to be a turning point. It has to be the moment where we once again get serious about the HIV epidemic.

What should we be getting serious about? Firstly, we must get serious about where we will find the healthcare workers to support an extra 20 million people on treatment. Secondly, we have to stop pretending we can end AIDS without dealing with the widespread dysfunction in our healthcare systems. Thirdly, we have to get serious about how we are going to produce and pay for the medicines needed to treat an extra 20 million people. Lastly, we need detailed, fully funded plans that will make treatment for all a reality.

Getting serious also means an unwavering commitment to the evidence in all aspects of our AIDS response. It means being guided by the scientific evidence rather than by what sounds good or by what “sells on the hill”. It means never again wasting money in the way money was wasted on, for example, abstinence-only programmes. It means standing up to the moral Mother Grundys and providing young people with proper sex education and access to condoms. It means asking “Why are we so quick to stigmatise ‘sugar daddies’? but so slow to ensure young people have easy access to condoms?”

Getting serious means addressing the political obstacles to fixing our healthcare systems. It means dealing with corruption, mismanagement and patronage in our healthcare systems. It means not turning a blind eye when healthcare systems are wrecked by people who are politically well-connected – as is happening in the Free State province here in South Africa. It also means acknowledging that while PEPFAR giveth, the United States Trade Representative taketh away – the latter by bullying poor countries into trade deals that compromise access to medicines.

Getting serious also means not tiptoeing around cruel and inhumane legislation such as the anti-gay laws in place in many countries. At a conference like the International AIDS Conference IAC, we must say loudly and clearly that what countries like Nigeria and Uganda are doing is unacceptable and an affront to our common humanity.

Getting serious means an end to empty rhetoric and spin. It means that UNAIDS must stop talking about an end to AIDS while there are 20 million people who still need treatment. We cannot spread complacency just because we want to tell a positive story. Our lives are not an advertising campaign.

At this point in the AIDS response, complacency is our greatest enemy.

Even though a staggering 20 million people still need treatment, we have allowed the spotlight to shift. We have allowed the world to think AIDS is no longer a crisis. To the extent that we have allowed this to happen, we have betrayed the 20 million people needing treatment today. We have no choice. We are morally obliged to change this in Durban.

Getting an extra 20 million people on treatment will not be easy. If we are serious about things like 90-90-90 then we are going to have to rock the boat. I know that most of us want to be polite and not offend anyone. But our moral obligation is not to ourselves, or our own comfort, but to the 20 million people who still need treatment. We have to say to the governments of high burden countries: “You have to invest more. You have to do better.” We have to say to rich countries that they have a moral responsibility to the people still dying of AIDS and their families. And if governments don’t do their part we must name and shame them and stop the quiet diplomacy.

We don’t have to go hat-in-hand to Geneva or New York. We don’t have to accept ‘no’ for an answer. If a house is burning with people inside, then we help. That is what it means to be human.

If we are truly serious about things like 90-90-90, then we have to once again turn our crisis into a crisis for our political leaders. Together we must demand that HIV and TB is on the top of the agenda when the G7 or G20 meet. We must demand that more money is invested in TB research. We must say ‘no’ to a world where the United States government spends US$600-billion a year on its military, but the entire world can only find US$700-million per year for TB research.

We have the moral authority to demand a second wave in the AIDS response. We have no choice but to use it.

Welcome to Durban 2016, let’s roll up our sleeves and get serious. We have 20 million more people to treat.   

Anele Yawa is the General Secretary of the Treatment Action Campaign.