By Dr. Mark Dybul, Executive Director, The Global Fund to Fight AIDS, Tuberculosis and Malaria
The story of the fight against HIV is the story of the human family coming together. A decade ago, the disease was snuffing out lives at villages and neighborhoods at a seemingly unstoppable pace. Life expectancy in entire countries was being cut down by a decade or more. The old and the young were dying in pain and all alone in their communities, shamed in many cases by their own families and friends.
Since then, courageous activism, political leadership and a massive increase in resources have changed the AIDS landscape dramatically. Scientific advances and our experience on the ground now give us the historic opportunity to end HIV as an epidemic and turn it into low-level endemicity. But to complete the job we need to be much smarter. That means investing in the right places, to make sure no one is left behind.
When we started together 12 years ago, the Global Fund could invest in virtually any intervention and have a big impact because the disease was everywhere and people were dying everywhere. Our goal then was to stop death and as many new infections as possible. Today, we are in a different time, one which will require more intelligent investments and more targeted interventions so that we can have the greatest impact.
Epidemiological intelligence is telling us that HIV is being pushed into “hot spots,” or pockets where the disease is most heavily concentrated and where high risk populations or people most at risk of having HIV live. These include women and girls, men who have sex with men, sex workers, people who inject drugs, prisoners and migrants, among others. They are the people most marginalized by society. This is precisely why equity needs to be at the heart of an effective response to HIV. If we want to increase the impact of our investments and accelerate the gains, we need to put the most vulnerable at the center of our health interventions. So when we talk about bringing the epidemic under control we look beyond the tyranny of averages and instead focus our efforts on areas and sub-areas of high transmission and on those most at risk, using the more refined epidemiological data that is available. Otherwise, we will continue leaving people behind and miss this window of opportunity. We also need to invest in stronger health systems and in developing community health workers, for more long-term impact on overall health and quality of life, strengthening economies and communities.
In the absence of a silver bullet against this modern-day plague, we can utilize the resources better by deploying all the panoply of tools we have at our disposal, from harm reduction to circumcision to making sure that all those who need it receive antiretroviral treatment. Treatment, for example, not only saves lives, but dramatically reduces the chances of infecting others. If we turn the HIV epidemic into a more fragile, low-level endemicity, a future generation of vaccines and technologies can deal the fatal blow.
The Global Fund was created as a unique 21st century partnership in global health. To achieve victory, partnership, commitment and shared responsibility need to continue inspiring everything we do. We’re all in this together – external funders, governments, NGOs, communities affected by the disease, faith-based organizations, activists and community groups and the private sector. If we galvanize ourselves around this historic moment, and act as one big human family, our children and their children will have to worry about other problems, but not HIV.