Time to take a cold, hard look

By Professor Peter Piot

With over 3 000 people dying from HIV infection every single day and 5 500 becoming newly infected, AIDS is not over by any means.

It is not over for the over 20 million people living with HIV who are not benefiting from antiretroviral therapy, and it is not over for all those who are stigmatised and discriminated against because they are living with HIV or are at high risk or vulnerable to HIV.

While it is important to celebrate some remarkable achievements and the lives of so many who were saved, it is urgent to take a cold and hard look at the massive old and new obstacles the AIDS response faces and how to overcome them. Not doing so may put the lives of entire generations at risk, and undo hard won gains.

The staggering new infection rates in young women in Southern Africa represent a shameful collective failure despite an increasing armamentarium of prevention methods, as are the continuing HIV epidemics in gay men, sex workers and injecting drug users.

HIV prevention has all but disappeared from the AIDS agenda in too many societies and among too many funders. It is an illusion that we will treat ourselves out of this epidemic, even if treatment efforts clearly have to increase and are having a positive impact on the epidemic. We must resolutely embrace and fund combination prevention tailored to the needs of specific communities.

The dwindling support for community and activist groups puts the entire AIDS response at risk in many countries and undermines its sustainability. Dedicated funding must continue.

Where are human rights in the AIDS response when in so many countries people with HIV are denied access to ART, are still rejected and homosexuality is illegal? The response must be grounded in both science and human rights to be effective and sustainable.

Innovation in terms of treatment and prevention tools has greatly supported the AIDS response. We now also need true innovation in the delivery of HIV prevention and treatment programmes, health system strengthening, community action and the prevention of stock outs.

Political leadership on AIDS is at risk and funding in many countries is stagnant. This is understandable as it is very hard to keep any issue on the agenda for decades, which is what is required to defeat AIDS. Now is the time to reinvigorate leadership and activism on AIDS, build new coalitions, and ensure long-term funding. The replenishment of the Global Fund this year must be a success as any decline in funding will have disastrous consequences.   

Professor Peter Piot is the Director of the London School of Hygiene and Tropical Medicine, Professor of Global Health.