DURBAN, South Africa — The 21st International AIDS Conference began with the question: “What will it really take to achieve the end of AIDS?”
With more than 15,000 delegates, journalists and others expected this week at the bi-annual conference, a lot of hype focuses on the upcoming ‘special session’ with Sir Elton John and Prince Harry of Wales on the stigma and discrimination of HIV among adolescents. But a group of high-profile experts and advocates drew its own standing-room-only crowd on Sunday to discuss the current state of AIDS in the world, which they say is at a critical crossroads.
“The international community has been very clear about setting ambitious global targets to end AIDS,” said Ben Plumley, CEO of Pangaea Global AIDS, an advocacy group with offices in Harare, Zimbabwe, and Oakland, California. “What has been less clear is the necessary platform of long-term actions needed to deliver these ambitions goals.”
Those goals include UNAIDS’ 90-90-90 trilogy: By 2020, 90 percent of all people living with HIV will know their HIV status, 90 percent will be receiving sustained antiretroviral therapy and 90 percent of all people receiving antiretroviral therapy will have viral suppression.
And, of course, the ultimate goal many here are debating: ending the AIDS epidemic by 2030 and the viable paths to get there.
Plumley and others at this two-hour session remarked that the attention of many leaders has been diverted by other health issues garnering more media coverage.
“It’s 1984 all over again,” bemoaned Plumley, referring to the early years of the epidemic, a time when many denied that the virus existed.
Peter Piot, director of the London School of Hygiene & Tropical Medicine and founding executive director of UNAIDS, remarked on the recent “sobering findings” of limited progress in reducing HIV infections, which have remained stubbornly high over the past decade with some countries even seeing increases in infections.
He referred to the report of the Lancet AIDS Commission, launched one year ago and pointed to four key dimensions:
- Need for a comprehensive strategy
- Implementation – addressing the needs of people left behind and so-called “stock outs” of drugs due to poor supply-chain management
- Effective financing on a long-term basis
- Global and national engagement
“The points made in the Lancet paper are only more acute,” Piot said. “The world is facing the greatest numbers than ever of young people having sex – just from sheer population growth.”
Piot also expressed concern about waning interest among some stakeholders and the reliance on what he termed “hashtag activism.”
Tsitsi Apollo, deputy director of HIV/AIDS and STI in the Zimbabwe Ministry of Health and Child Care, also expressed concern about persisting issues, especially among girls and young women.
“I see young people facing the same issues I faced when I was diagnosed 15 years,” Apollo said. “Stigma is as bad ever. There is no sign of the end of AIDS at the community level.”
Piot echoed that theme: “There are five new infections in London among gay men every day.”
He also cited a 12 percent drop in funding for AIDS-related services and medications.
Piot’s comments are underscored by a recent report from UNAIDS and the Kaiser Family Foundation. That report notes funding from government sources to support HIV efforts in low- and middle-income countries fell for the first time in five years in 2015, decreasing from $8.6 billion in 2014 to $7.5 billion.
On the national level, data gathering and reporting systems need to be uniform, so that governments on the provincial and national levels have a stronger and effective grasp of their people’s needs, said Nduku Kilonzo, director of the National AIDS Control Council of Kenya.
In addition, she said, “any successful program must be driven by country priorities and use country systems, otherwise it becomes a project that goes away at the end of the funding cycle.”
She also remarked on the imperative to change the model of delivering health services, implying repeated failures have not led to improvement by referencing the Albert Einstein’s famous quote, “Insanity is doing the same thing over and over again and expecting different results.”
So what will it take to end AIDS?
“We need to bring up a new generation of leadership on this issue,” Piot said. “And we will only gain by speaking truth to power.” Moreover, those in power he said need to “face the reality we here (at this conference) are facing. It is possible that all the gains we have made will be wiped out.”
