Post-2015 Millennium Development Goals affirm a future free of AIDS—but is this enough?

December 18, 2014

Three days after World AIDS Day, UN Secretary General Ban Ki-moon released the report Road to Dignity by 2030: Ending Poverty, Transforming All Lives and Protecting the Planet. This Synthesis Report aims to provide a roadmap beyond 2015, when the 2000 Millennium Development Goals (MDGs) expire. Among the MDGs is the reversal of the spread of HIV and the achievement of universal access to antiretroviral treatment (ART) for all in need. The MDGs are widely considered to have accelerated the changes in the global epidemic since 2000: Over the last fifteen years, global access to ART increased to an estimated 13 million people and there was a 38 percent reduction in new HIV infections. The MDGs were the backdrop for the “3 by 5” initiative, launched by UNAIDS and WHO in 2003 to provide three million people with ART by the end of 2005.

So what is next? The Synthesis Report addresses the unfinished business of the MDGs as well as new health priorities and challenges, including non-communicable diseases and neglected tropical diseases, and universal coverage and equitable access to health care. The report clearly states this new agenda must “…realize the vision of a future free of AIDS…” This goal, however laudable, is the only reference to future work on HIV/AIDS in all of the report’s almost 50 pages.

Should HIV advocates be concerned about the lack of specific HIV goals? Is this retrenchment—a move away from the previous global commitment? Even if it isn’t, will it be perceived as such by governments or civil society? The short answer: probably not. The AIDS advocacy and activist movement(s) do not need to spend time concerned about lack of detail in the post-MDG goals. There are other frameworks, such as the UNAIDS “90-90-90” campaign, that stakeholders need to put into action to achieve the end of the AIDS epidemic by 2030. Within this work, there’s a need to guarantee that ART reaches everyone who needs it—particularly, women, sex workers, men who have sex with men, transgender people, injection drug users and prisoners. And we need to be sure that care and treatment services and medications are high quality, leading to virologic suppression. That’s a hefty task that will only be achieved with concerted, re-invigorated partnership between civil society, policy makers and program implementers—a level of collective strategizing and collaboration that we haven’t seen before. That’s where the real work is needed.

Worrying about the post-2015 MDG agenda could overstate the role they played in the progress we, the global HIV community, have made, which likely also came from leadership, advocacy and trends independent of the MDGs. The rapid reduction in the price of antiretroviral drugs was key to expanded treatment access. Changes in political leadership were also critical in places such as South Africa. Some bilateral programs such as PEPFAR were not MDG driven. Finally the domestic health response has escalated with low- and middle-income countries investing US$ 9.65 billion in 2013.

The new post-2015 development goals laid out in the UN’s Synthesis Report do not deprive the HIV/AIDS field of a rallying call. Three years ago, people already began talking about ending AIDS—a goal beyond the imagination of the MDG architects. The call to end AIDS, UNAIDS’ 2014 90/90/90 target, and now realizing ” …the vision of a future free of AIDS …” in the Synthesis Report, should carry us forward to 2030.