At the peak of the AIDS epidemic in the 1990s, HIV, the virus that causes AIDS, was infecting close to 3.7 million people each year. Even when new infections started plateauing in the 2000s and then steadily started declining, it was still unthinkable to imagine a world without AIDS.
Not anymore. Ending the AIDS epidemic is within reach, says Michel Sidibé UNAIDS Executive Director and Under-Secretary-General of the United Nations. In an exclusive interview on his India visit, Sidibé tells Hindustan Times how UNAIDS’ ‘Getting to Zero’ blueprint will help countries achieve the global targets of zero new HIV infections, zero discrimination and zero AIDS-related deaths by 2030.
The grand plan
UNAIDS has adopted a ‘Fast-Track’ approach to end the AIDS epidemic as a public health threat by 2030. It involves front-loading investment over the next five years to reach an ambitious 90-90-90 treatment target by 2020. Reaching this target would see 90% of people living with HIV knowing their HIV status, 90% of people who know their HIV-positive status accessing treatment and 90% of people on treatment having suppressed viral loads.
The fast-track approach will also reduce new HIV infections by 75% and realise our vision of zero discrimination.
To be successful, the fast-track approach must be grounded in human rights and put people at the centre. People are being left behind because they continue to face stigma and discrimination, human rights violations, gender inequity, violence and punitive laws.
For example, ensuring that women and girls are empowered to protect themselves from HIV is crucial. Their human rights must be respected, including the right to make decisions about their own health and the right to assume control over matters related to their sexuality, including their sexual and reproductive health.
Sex workers, gay men and other men who have sex with men, transgender people, people who inject drugs, prisoners and migrants must be able to access appropriate services and targeted programmes.
Watch: Michel Sidibe on World AIDS day, 2014
We are at a historic moment in the AIDS response. The next five years provide a fragile window of opportunity to end the AIDS epidemic. Reaching the Fast-Track Targets by 2020 means that the epidemic will be broken and from 2021, less money will be necessary each year to end the epidemic by 2030.
Increasing current investments by US$ 12 billion a year would produce benefits of more than US$ 3.2 trillion that extend well beyond 2030 -- a return on investment of nearly US$ 17 for every US$ 1 invested.
Most importantly, it would end the AIDS epidemic as a public health threat by 2030, saving millions of lives. But if we don’t act now, this window will close and the epidemic could rebound.
Reaching people in conflict zones
Providing HIV-related health and other basic services to displaced people is a difficult yet critical undertaking. Living conditions for refugees and internationally-displaced persons (IDPs) are often challenging. Even where services exist, they may have collapsed or be disrupted. Other factors to consider are the level and type of stigmatisation and discrimination such populations may face, especially those living with HIV. UNAIDS works with partners and civil society to ensure that people can continue to access vital health services in conflict situations.
Since the early days of the epidemic, when Thailand’s 100 percent condom programme for sex workers became a global model, Asia and the Pacific (region) has had an innovative response to HIV. More recently, last year Thailand began providing HIV treatment to everyone living with HIV as part of its universal healthcare coverage.
Cambodia has also moved from 20,000 new infections a year to less than 1,000 new infections a year with a strategy that focuses on key populations. China’s dynamic harm-reduction programme for people who inject drugs has helped stop a rapidly-expanding epidemic among people who inject drugs.
India has played a pivotal role in the response to the AIDS epidemic, especially in Africa. Fifteen years ago, treatment coverage in sub-Saharan Africa was virtually nil; now more than 11 million people in the region have access to life-saving medicines and more than 80% of antiretroviral medicines (to treat HIV) in Africa are sourced in India.
Going forward, it’s crucial that India continues to support Africa’s effort to build its own pharmaceutical industry through sustained investment and technology exchange. Local production of medicines is critical to bring treatment to all people affected by HIV.