This month, the United Nations General Assembly held a special session to review progress in the fight against AIDS and to decide on a new global plan of action to tackle the epidemic. This historic meeting brought together government leaders from all countries as well as advocates from medical, scientific and community sectors and people living with HIV from all parts of the world.
This special General Assembly meeting coincided with the 30th anniversary of the first public report of AIDS in June 1981 — a brief report noting a peculiar cluster of unusual pneumonia cases in five otherwise healthy gay men. Today the epidemic affects every part of the world and has claimed more than 30 million lives. Another 33 million people are living with HIV and there are some 7000 new infections every day, mostly among young people. Some 16 million children have been orphaned because of AIDS.
Even though powerful new HIV treatments are making a tremendous impact in reducing illness and AIDS related deaths, the sustainability of providing HIV treatment — especially in low to middle income countries — is threatened by the reality that for every one person put on treatment, another two people become infected. Costs must be brought down and the pace of the epidemic slowed if we are to make providing HIV treatment sustainable for the millions of people who will need it.
The answer to reducing new infections is prevention, prevention and more prevention. In fact Michel Sidibe, the Director of the UN’s HIV agency, UNAIDS, has called for a prevention revolution that makes every person aware of HIV, tackles stigma and discrimination about HIV and makes condoms, clean needles and syringes widely available. Sidibe notes that future prevention efforts must also capitalise on the latest scientific findings, including that using HIV treatments earlier not only helps the individual living with HIV, but also reduces infectiousness, resulting in fewer new HIV infections.
Ten years ago the United Nations adopted its first Declaration of Commitment on AIDS, a comprehensive global plan for fighting HIV. While the plan contained excellent elements and has been important in helping guide the global HIV response, it was fatally flawed in one area: it didn’t name the three groups who are universally at higher risk to HIV, namely, men who have sex with men, people who inject drugs and sex workers.
A group of countries adamantly refused to allow these groups to be listed in the first Declaration and instead insisted that they be obliquely referred to as "vulnerable groups". This decision to deny the reality of who is at higher risk has arguably cost many new HIV infections and lives. It has hindered HIV prevention efforts, misdirected many millions of dollars in targeting populations at low risk of HIV, instead of directing money and effort where it would have the greatest impact.
This time, finally, and against all the odds, the United Nations was able to agree for the first time to list in their new Declaration these three key groups that all countries need to give high priority to in their HIV prevention plans — along with targeting other populations at risk, depending on the pattern of each country’s HIV epidemic. If countries implement this much more strategic approach to HIV prevention, there is the potential to dramatically slow the rate of new HIV infections.
As well as calling for HIV prevention to be better targeted and scientifically based, the new UN Declaration contains an extensive list of new commitments. Bold targets have been endorsed to reduce rates of new HIV infections from sexual transmission and injecting drug use by 50 per cent by 2015. Countries have also agreed that HIV transmission from mother to child must be eliminated by 2015 as a response to the appalling statistic that around 370,000 babies are infected with HIV annually.
While the UN Plan reiterates that prevention must be the mainstay of the global HIV response, the urgency of expanding HIV treatment is acknowledged through a commitment to ensure that another 14 million people are able to start HIV treatment by 2015, as part of a goal of providing universal access to HIV treatment for all in need.
Other important commitments in the plan include calling for better coordination and monitoring of HIV programs, measures to help strengthen health systems and a call for all countries, not just donor countries, to assume greater ownership and funding of their HIV responses.
At the end of the day, the new United Nations Declaration on HIV will stand or fall on the willingness of governments to implement it. This will require political leadership, scientific guidance and forceful advocacy. However, the willingness of all countries to adopt a new Declaration on HIV, with its important new commitments, goals and targets, is a truly hopeful sign that the global response to HIV can be revitalised and that a world without AIDS can be a reality.
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