No Turning Back in Fighting AIDS

August 12, 2014

This first appeared on PSI’s blog, Impact

The 20th International AIDS Conference marks a pivotal moment in the fight to end the AIDS pandemic – one that captures both the promise and the challenge of the years to come.

The past decade of financial and political commitment has resulted in a major expansion of access to HIV prevention and treatment services around the world. The public health impact of this commitment is both significant and unprecedented. Nevertheless, the gains are fragile and more must be done to reach everyone in need.

Almost three years ago, the United States government revitalized its commitment to ending AIDS through the ambitious goal of reaching an AIDS-free generation. Bipartisan support for the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the U.S. contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria, continues to bring us closer to meeting this goal. Last year, President Obama announced that his target for supporting 6 million people on treatment by the end of 2013 was ahead of schedule. And Secretary of State John Kerry announced that 1 million babies globally have been born HIV-free thanks to PEPFAR support.

PEPFAR has been instrumental also in one of the most impressive turnarounds in the global response to AIDS, providing access to voluntary medical male circumcision (VMMC). VMMC has been shown to reduce a man’s chances of acquiring HIV from a female partner by nearly two thirds. PEPFAR had supported 4.7 million circumcisions by the end of 2013.

This support has been critical. Investments in the global AIDS response are working. In 2012, there were 2.3 million new HIV infections, the lowest number of annual new infections in almost a decade. Twenty-six countries have seen a 50 percent or greater drop in new HIV infections since 2001.

Globally, new partnerships are emerging – 53 percent of all HIV-related spending in 2012 came from the governments of countries tackling the epidemic domestically. Costs of treatment have also decreased dramatically. In the mid-1990s first-line antiretroviral therapy was $10,000 per person per year. In some low- and middle-income countries today it is $140. Through this efficient use of resources and an increased investment, we stand poised to reach an important ‘tipping point’ in the fight against HIV and AIDS, in which the number of individuals receiving HIV treatment exceeds the number of new HIV infections.

Sadly, the challenges ahead of us remain daunting.

To date, 16 million people in Africa who are eligible for antiretroviral therapy cannot access treatment. The treatment-eligible children living with HIV in sub-Saharan Africa are only about half as likely to receive antiretroviral therapy as HIV-positive adults. And though HIV rates are declining globally, rates for certain key populations appear to be rising in several regions.

Yet international support for HIV efforts has remained flat or – as in the case of PEPFAR – dropped in recent years. Without expanded and sustained investment in cost-effective treatment and evidence-based prevention, there is a very real danger that we will reverse the prevention gains of the last decade.

As Secretary Clinton said when she launched the US Blueprint for an AIDS Free Generation: “The goal of an AIDS-free generation may be ambitious, but it is possible with the knowledge and interventions we have right now.”

It would be a great tragedy to miss that opportunity. Rather than fall behind, we must step up the pace and end this once and for all.

We’ve come too far to turn back now.