Mitchell Warren is the Executive Director of AVAC, a leading HIV prevention advocacy organization, and Chris Collins is the Vice President and Director of Public Policy at amfAR, The Foundation for AIDS Research. The joint AVAC/amfAR report, An Action Agenda to End AIDS, is available at www.endingaids.org.
The International AIDS Conference wrapped up in Washington, DC last month with near-universal agreement that the end of the AIDS epidemic is a realistic, if long-term and aspirational goal. From Hillary Clinton to protesters who converged on the White House lawn, nearly all spoke of the opportunities brought on by breakthroughs in HIV prevention and treatment research – and of the need to quickly translate “ending AIDS” rhetoric into action.
Yet two fundamental questions hung over the proceedings: What exactly is the end of AIDS? And what must we do, today, to start making it a reality?
To us, ending the epidemic means drastically reducing new HIV infections, while preserving the health of everyone living with HIV. AIDS will not truly be over until we have a cure and a vaccine that is globally available. But, until then, transmission of HIV and death from AIDS can become rare events, allowing the vast majority of humanity to live without fear of one of history’s greatest scourges.
This is an ambitious vision, and it is achievable if we make smart use of the HIV prevention and treatment options available today, while continuing the search for a vaccine and a cure. It will require clear priorities, ambitious and achievable targets, sustained funding and effective ways to hold ourselves accountable for progress.
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In short, the world needs a business plan to end AIDS.
Some might take issue with likening the global AIDS response to a business. The fight against AIDS has no CEO, no board of directors, no clear reporting structure. It is a dynamic and often messy alliance of governments, funders, advocates, researchers and people affected by AIDS in every part of the world. And it has been remarkably successful: 8 million people are now receiving life-saving antiretroviral therapy, and new HIV infections and AIDS deaths are on the decline.
The successes we have seen to date have been driven by advocacy, public will, and scientific advances, along with many of the same factors that define a successful business, including clear objectives and accountability.
As an example, in 2003, the World Health Organization (WHO) set the goal of getting 3 million people onto treatment by 2005 – the so-called “3 by 5” initiative. The target was ambitious but specific, and it helped donors, developing countries and advocates focus their efforts and do whatever it took to expand access to treatment. WHO and others closely tracked progress against the target, and advocates used these progress reports to hold national and international leaders accountable.
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In the end, we didn’t achieve the target on schedule. But now, just a few years later, we’ve exceeded it almost threefold. If not for the “3 by 5” rallying cry, we would not have achieved “8 by 12”.
At the recent AIDS conference, our organizations presented a proposal for the global business plan to begin ending AIDS, available at www.endingaids.org. It identifies essential short-term actions for every major group of stakeholders. And while opinions will differ on some of the specifics, three key actions will be essential.
First, international agencies and donors need to agree on a limited set of global priorities and targets through 2015. For example, it should soon be possible to achieve a “tipping point” at which – for the first time ever – the number of people gaining access to antiretroviral treatment outpaces the number of people becoming newly infected. AIDS leaders should make this a formal objective, and define the steps needed to get there.
Second, every country needs its own business plan for ending AIDS. Many countries do, in fact, have national AIDS plans. These need to be updated to reflect the latest advances – from voluntary medical male circumcision (VMMC) and pre-exposure prophylaxis (PrEP) for people at risk for HIV, to early initiation of antiretroviral treatment, for which evidence presented at the conference demonstrated HIV-infected patients do better, their partners are protected and it is very cost-effective. Plans must include monthly, quarterly and yearly targets that define success.
Third, we all need to focus our resources on the combinations of tools that can have the greatest impact. For example, there is an urgent need to scale up VMMC in key African countries, where it could help prevent 3.4 million new HIV infections by 2025. More than five years after VMMC was shown to dramatically reduce the risk of HIV transmission, circumcision campaigns are barely off the ground in many of these countries.
If ending AIDS truly were a business, today would be the best time to invest. We have many of the tools that will be needed, and we have evidence that success is possible. Now, it is time for a milestone-driven and monitored plan.
For more of GlobalPost's coverage of the fight against AIDS, check out our Special Report "AIDS: Turning Point."