I attended the 2008 High Level Meeting on AIDS at the UN. Here is some of what I learned.
The Good News
Progress in containing the HIV epidemic is now being seen in nearly all regions of the world. Even in some of the most resource-constrained settings, life-preserving HIV treatments are being scaled up and changes in sexual behavior are reducing the number of new infections. The world is starting to reap the benefits of the unprecedented investments made during the present decade in responding to the epidemic. These results illustrate what can be achieved when there is global resolve, political commitment and active engagement of people living with HIV and affected communities.
The Bad News
These positive results are not uniform across or even within countries. In some parts of the world new infections continue to increase while coverage for HIV prevention, treatment, care and support remain far too low to have any impact on the course of the epidemic. The sad truth is that for each person started on HIV treatment in 2007, 2.5 more persons were infected. An estimated 33.2 million people worldwide were living with HIV as of December 2007. Women represent half of all HIV infections among adults, but 61% of those infected in sub-Saharan Africa.
HIV and the Millennium Development Goals (MDGs)
The MDGs are linked. Progress in one leads to possibilities in another. While the response to HIV is specifically linked to MDG, 6 it supports the achievement of most of the other goals. In fact, unless we are successful in combating HIV/AIDS the achievement of the other goals will probably be impossible. HIV/AIDS is wreaking economic havoc across the world. It strikes the most productive members of society, killing them slowly, and drawing others from the workforce and out of school to care for them. The spread of HIV/AIDS in rural areas is having a dramatic impact on food security. When farmers are affected by the disease they tend to plant fewer crops. HIV/AIDS and food security are entwined in a vicious cycle: food insecurity heightens exposure to HIV/AIDS infection, and HIV/AIDS heightens food insecurity.
The impact of HIV/AIDS on Goal 2 – the achievement of universal primary education has been devastating. In sub-Saharan Africa, more teachers are dying of AIDS than are being trained.
With more than half of HIV-infected infants dying before the age of two, the prevention of mother to child transmission and the provision of pediatric treatment will support progress toward Goal 4, to reduce child mortality.
What can be done?
The HIV/AIDS pandemic must be recognized as a public health as well as a development issue.
Therefore, an effective response to the pandemic must become a central feature of all development efforts. This means that strengthening public health systems, including by stemming the brain drain, must go hand in hand with a effective national strategies to combat HIV/AIDS.
An effective response to the epidemic must have human rights and gender equality at its core. The rights of people living with AIDS, and other vulnerable groups must be protected, including women’s rights to make informed decisions about their sexual health. Stigmatization and discrimination, including travel restrictions, drive the pandemic under-ground, from where an effective response becomes impossible.
Finally, there must be better access to prevention, treatment, and support services, especially for those populations at most risk. We must have better public education programs, particularly for young adults. Prevention and treatment must be more accessible to everyone, including drug users, sex workers, and sexual minorities. And, preventing HIV transmission from mother-to-child must be eliminated in developing countries, as it has almost been in developed countries.
Our response to the pandemic must be inclusive. Governments, community leaders, civil society and other international actors are all part of the same team. Our collective efforts must be joined-up, complementary and coherent. We must better integrate policies and approaches that address HIV/AIDS, TB and drug-use to reflect the multifaceted nature of the pandemic. The UN system must have the capacity to ensure that national efforts are coordinated and complementary.
Leadership and political accountability are the most important part of the solution. It is of particular importance to involve youth as an integral part of the solution as they have the most to lose.