Every two years, the International AIDS Conference gives us a chance to take stock of where we are in our struggle against this epidemic – of where we have come, and where we need to go. We have learned many important lessons in responding to HIV and AIDS over the past 35 years (lessons that I fear we sometimes forget), and this session provides us with a key opportunity to remember some of the most important things that we have learned:
First, while we need to recognize (and celebrate) the important accomplishments that we have achieved in the scale-up of the global response to HIV during recent decades, we also need to be realistic about the challenges that still exist.
Let me give just a few examples:
- Today, in 2016, 20 years after Vancouver, roughly 50% of the people in the world who need access to HIV treatment still don’t have it. We should celebrate the number of people on treatment, but we can never forget those who still don’t have access – and the pain, suffering and death that they have been subjected to because of the world’s inability to take the necessary action.
- Also, after massive increases in funding for the global response to HIV, available aid has plateaued in recent years – and we now know that in 2015, aid for HIV declined for the first time in the past 5 years, falling from 8.6 billion US dollars to 7.5 billion – a significant drop that signals a level of global complacency about the epidemic. At least in part, it is fair to conclude that this complacency is a result of the premature declaration of ‘the end of AIDS’ on the part of many of the leading agencies and officials responsible for ‘administering the epidemic’. It is a failure of leadership.
- Finally, while we have seen great progress in developing new prevention technologies, collectively we have failed miserably in making them available where they are most needed. We have failed to build and sustain community-based education programs. In their place, we have substituted slogans, such as ‘Treatment as Prevention’ (even though we treat only 50% of those who need it) and programs, such as ‘Test and Treat’ (even though beleaguered health and social systems in poor countries and communities have repeatedly failed to adequately meet the needs of those who test positive for HIV). Worse yet, such approaches have increasingly become a kind of smoke screen that covers up the reality of ‘scale-down’ (rather than ‘scale-up’) in many countries – a smoke screen that has too often served as a justification for cutting funding for meaningful prevention programs based on community engagement and ownership.
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