In commemoration of World AIDS Day, Dr. Joia S. Mukherjee describes why this is no time for complacency in the long, global battle against the deadly disease:
World AIDS Day is always a reminder. A reminder of those we have lost in the almost four-decade struggle against AIDS. A reminder to reflect on the greatest global victory of the 21st century. The collaborative global community response is to provide AIDS treatment to all as a basic human right. In an era where bad news and fragmentation reigns, the global response to the AIDS pandemic represents the most commendable aspects of humanity; a willingness to intercede on behalf of the common good.
Partners In Health has proudly 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 long-term treatment.
This paradigm shift has ushered in a new era in global health, resulting in stronger, more resilient health systems with the capacity to treat a variety of conditions, from non-communicable diseases, mental illness and cancer to women’s and children’s health needs. Adult, child, and maternal mortality have dropped in many of the world’s poorest countries.
The success of this movement should not be underestimated. In 2000, only 685,000 people with HIV had access to antiretroviral therapy—the life-saving medications that have transformed AIDS from a fatal disease to a manageable and treatable condition. This year, UNAIDS announced that as of June 2017, 21 million people living with HIV worldwide had access to antiretroviral therapy. Yet our work is far from over.
Scientific evidence has shown—and I firmly believe—that it is possible to end the global AIDS pandemic. However, to do so, 90 percent of people with the disease must be on effective treatment so that they do not spread the virus. More money is needed to achieve this goal. Treatment must be provided to the 17 million people living with the disease who are not on antiretroviral therapy.
We also need second- and third-line drugs for those currently on HIV drugs who are living longer and whose disease eventually develops resistance to their drug treatment. It is important that people on antiretroviral therapy get tested regularly to detect the presence of resistant strains. We have the technology to regularly monitor for resistance and without this critical step, people may die of resistant, but treatable, HIV. In addition, failure to implement new diagnostics and drugs could lead to a second wave of death and new infections. Lastly, preventive therapy must be expanded with PrEP, a single drug for those whose sexual partners are HIV positive.
As the U.S. Congress enters a contentious December of budget-wrangling and spending debates, we must voice our support for expanding global health funding. The U.S. must increase its support of the Global Fund, and increase funding of the President’s Emergency Plan For AIDS Relief (PEPFAR).
Investing in these steps now is critical to end the global pandemic. Increased international funding is needed to combat the major epidemics of our time and to achieve universal health coverage as part of the UN’s Sustainable Development Goals. The gains against HIV and improvements in health will be lost if we lose focus of the fundamental principle that health is a cornerstone for global development.
World AIDS Day is a time to celebrate past successes. Impacts from PEPFAR and the Global Fund have amounted to a sea change for people living with HIV. The World Health Organization 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, saving more than 13 million lives.
But rather than make us complacent, these victories should serve as a reminder that we can do better, and that we can accomplish great things through collaboration and solidarity. Forty years into the war against HIV, on this World AIDS Day, we must commit to end the epidemic and fight for health for all.
Dr. Joia S. Mukherjee is the Chief Medical Officer of Partners In Health, an associate professor in the Division of Global Health Equity at Brigham and Women’s Hospital, and an associate professor in the Department of Global Health and Social Medicine at Harvard Medical School.