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Renewed activism, not budget cuts, needed to end the AIDS epidemic

Policy makers, organization, and governments have worked side-by-side with people living with AIDS as part of a global social movement for three decades. The success of the movement for HIV treatment access not only garnered billions of dollars of new money for HIV treatment, but also served to shift the public health paradigm from prevention-only to the provision long-term treatment. This paradigm shift ushered in a new era in global health. One that has strengthened health systems and treated a variety of conditions from non-communicable diseases, women’s health, mental illness, and cancer. Stronger and more resilient health systems are the result. Adult, child, and maternal mortality have dropped in many of the world’s poorest countries. UNAIDS recently announced that as of 2017, 21 million people have received antiretroviral therapy—the life-saving medications that have transformed AIDS from a fatal disease to a manageable and treatable one.

The establishment of health systems lays the needed groundwork for health care delivery. It is imperative in this new era of global health that we use science and data to continue to improve the quality of care, fight epidemics, and progressively avert more suffering and disease. The data is clear: it is possible to end the global AIDS pandemic. To do so, the international community must commit more resources to achieve the target of 90-90-90 (that ninety percent of people with the disease know their status, ninety percent of those with AIDS are on ART, and ninety percent of those on ART have undetectable virus). While the reach of global AIDS programs to treat 21 million people is remarkable, there remain 17 million people living with the disease who are not yet on antiretroviral therapy.

…the reach of global AIDS programs to treat 21 million people is remarkable…

In addition, second- and third-line AIDS drugs are needed. Millions of people on ART are living longer and have already or will eventually develop resistance to first line drugs. Programs must scale-up regular testing for circulating and resistant virus so that new drugs may be added as needed. Without this critical step, people will die and a second wave of new infections with resistant virus may occur. Lastly, preventive therapy must be expanded with PREP a single drug for those whose sexual partners are HIV positive.

As US Congress undergoes a December of budget-wrangling and spending debates we must voice our support for expanding global health funding, increasing US support to the Global Fund and increasing the PEPFAR budget. Investing in these steps now is critical to end the global pandemic that has been with us for almost four decades. The gains against HIV and improvements in health writ large will be lost if we lose focus on health as a cornerstone for global development. Sustained international funding is needed to combat the major epidemics of our time and to achieve Universal Health Coverage as part of the United Nation’s Sustainable Development Goals.

Each year on 1 December, it is World AIDS Day. It is a reminder. A time to remember those we have lost in the almost four-decade struggle against AIDS. World AIDS Day is also a time to reflect on the greatest global victory of the twenty first century—the collaborative global response to provide AIDS treatment for the most vulnerable which now claims 21 million people on AIDS treatment worldwide. In an era where bad news and fragmentation reigns, the global response to the AIDS pandemic is without peer in demonstrating a positive side of globalization.

…new HIV infections fell by nearly 40 percent between 2000 and 2016…

The WHO reports that new HIV infections fell by nearly 40 percent between 2000 and 2016, and HIV-related deaths fell by a third in that time 13.1 million lives saved. But rather than make us complacent, these victories should serve as a reminder that we can do better, we can accomplish great things through collaboration and solidarity. 40 years into the war against HIV, we must commit to end the epidemic and fight for health for all.

Featured image credit: Cafe by Christian Battaglia. CC0 public domain via Unsplash.

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