Bill & Melinda Gates Foundation

Up for Debate: Turning the Tide on AIDS

December 03, 2012

What will it really take to end AIDS? The Skoll World Forum and Impatient Optimists have co-produced a blog series to answer this question. We'll publish two posts/day over the next three days.

According to the latest report by UNAIDS, new HIV infections have dropped more than 50% in 25 low and middle-income countries. Last week, U.S. Secretary of State Hillary Clinton unveiled what she described as a  blueprint for an ‘AIDS-Free Generation’. There may not be consensus on how best to tackle the AIDS pandemic, but it is impossible to doubt the depth of global commitment. However, while we celebrate this progress, we must still confront the challenges ahead. What will it really take to end AIDS? We asked some of the world's leading experts and innovators—representing the UN Global Plan, mothers2mothers, (RED), Riders for Health, ONE Campaign, the Center for Gender Health and Equity, and the Gates Foundation—to highlight key challenges moving forward, and how we can overcome them.

Over the past decade, the world has made huge progress against HIV. According to the latest data released by UNAIDS, the global rate of new HIV infections has fallen dramatically with the greatest reductions in Africa. This includes declines of 73 percent in Malawi, 71 percent in Botswana, 50 percent in Zambia, and 41 percent in South Africa and Swaziland.

We have also made measurable progress in expanding access to HIV treatment while reducing the cost of HIV medicines by more than 99 percent. It is hard to imagine another investment where the relationship between cause and effect is so clear. Providing women, men, and children with anti-retroviral (ARV) medicines, at a daily cost of less than $1 per person, literally means the difference between life and death. Access to treatment has revived entire communities by nearly eliminating mother-to-child virus transmission and helping adults with HIV lead healthy and productive lives.

These positive trends have inspired justifiable optimism that we are starting to turn the tide on AIDS. But despite evidence of measurable progress, it’s important to recognize that we still don’t have all of the tools that we need to end AIDS. While the rate of new HIV infections is going down, the epidemic continues to outpace efforts to control it.

The number of newly infected people each year outnumbers those who gain access to treatment by two to one. And while more than 8 million people worldwide have gained affordable access to treatment – a major achievement – there are about 26 million people worldwide who will need treatment soon or are not yet able to access the treatment they already need.

This means that we still have an essential moral obligation to discover, develop and deliver new and better ways to help people protect themselves from HIV infection. The good news is that we are making progress in this area as well.

Research has demonstrated conclusively that voluntary medical male circumcision reduces an adult man’s chance of acquiring or transmitting HIV by at least 60 percent, and it confers lifelong protection. Many African heads of state in countries with high HIV burdens have embraced these results and are working with support from global donors, traditional leaders, and civil society organizations to raise awareness of circumcision’s benefits and expand access to it.

In the past year, clinical trials have demonstrated that individuals who take a once-daily dose of a standard HIV treatment, can greatly reduce their chances of contracting HIV from infected partners. The U.S. Food and Drug Administration recently approved that treatment as an HIV prevention method.  Research continues to evaluate whether ARVs infused into a vaginal gel can protect women against HIV infection.  Even more exciting is early stage research to discover and develop new family planning methods that could provide dual protection against HIV and unintended pregnancy.

Promising advancements in vaccine research have also reignited hope that we can identify and produce a safe and effective HIV vaccine to protect all future generations.  For the first time ever, researchers have identified a vaccine candidate that provides a significant level of protection against HIV infection, and the recent discovery of multiple antibodies that can neutralize nearly every strain of HIV has opened exciting new pathway to vaccine development.

Beyond advancements in research and development, countries have also made major progress in improving the efficiency of HIV treatment and prevention.

Since its creation a decade ago, the Global Fund to Fight AIDS, Tuberculosis and Malaria has dramatically and steadily increased the impact of the money that donors have invested in it. It has worked with public and private sector partners to reduce the cost of HIV treatment. It has helped developing countries adopt cost-effective approaches to HIV diagnosis, treatment and prevention. And it has practiced zero tolerance for fraud – an approach that has earned the Global Fund a well-deserved reputation as one of the world’s most transparent and accountable development organizations.  Had the Global Fund and PEPFAR not been created, millions of men, woman and children now alive would not have been given that opportunity.

In tough economic times, advocates can play a critical role in strengthening support for AIDS funding by reminding their leaders not only of the moral imperative to sustain this successful fight, but also of the huge social and economic value that their investments in HIV are delivering every day. By sustaining our commitment to the discovery and development of new prevention methods, and to further improving the coverage and efficiency of existing treatment and prevention tools, we can accelerate the ebbing of the AIDS tide.

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