Getting Ahead of AIDS: The Long-term Agenda

Since 1981 roughly 65 million people have been infected with HIV, about 25 million have died from AIDS, and 40 million people—the largest number ever—are living with HIV worldwide, according to UNAIDS estimates. Yet, in the history of AIDS, Executive Director of UNAIDS Dr. Peter Piot sees 2005 as the "least bad" year: "There have never been good years, but it was a year when hope slowly took over from pure despair in many communities." This year, 2006, marks the 25th anniversary of the clinical discovery of AIDS and the 5th anniversary of the special session of the United Nations General Assembly devoted to AIDS, which, according to Piot, elevated the disease from a "public health problem to one that is discussed at a top political level." Acknowledging both of these anniversaries, Piot and United States Representative Jim Leach (R-IA) spoke at a Wilson Center Director's Forum on Thursday, March 9, 2006, about the long-term agenda for fighting HIV/AIDS.

Piot outlined key developments in the struggle to get ahead of AIDS. In 2005, major funding increased at a record rate; AIDS programs began to operate with far greater efficiency; and "there was very welcome new proof from every continent that we can get ahead—that our investments are making a difference," he said. Additionally, the leaders attending the 2005 G8 summit in Gleneagles, Scotland, committed to providing universal access to essential HIV programs, which according to Piot, is an "essential next step and the only way to change the trajectory of the epidemic."

Despite these advances, the AIDS pandemic is still an emergency. In late May 2006 UNAIDS will issue a report that reviews—country by country—the world's progress in fighting AIDS. "The picture is a mixed one," Piot said, "with good progress in some countries, no progress in others, and many countries in the middle." He noted some sobering findings: "Only 1 in 10 pregnant women in the world today has access to the means to prevent mother-to-child transmission of HIV." Despite the discovery of antiretroviral treatment (ART) 10 years ago—which has prolonged the lives of HIV-positive patients for 20 to 40 years with consistent treatment—"only one in five people living with HIV who need ART has access to it," said Piot.

Piot outlined seven critical action items to ensure continued political, operational, and technical advances. He called for innovation, behavior-change campaigns, and efforts to address the drivers of the epidemic, as well as "hard work in the trenches," good management, leadership, and strategic investment. This hard work, he noted, must be coupled with increased funding and bolstered health care delivery, especially in severely affected countries where "we need to start effectively countering social and economic effects." In conclusion, Piot said, "I believe we're coming into the beginning of the end of the epidemic. And here, U.S. leadership is irreplaceable."

Echoing Piot, United States Representative Jim Leach said that "discovering techniques to eradicate the disease is the most important health challenge ever." While he had always considered war and peace the most critical world issues, "it may be the case that the disease challenge is greater than the war challenge." Leach pointed out that "we spend 30 times more on the war in Iraq than we do on AIDS," yet AIDS has killed more people than the war. "If you use death as a standard index, our priorities are skewed by about 7500 to 1 in terms of how money is allocated in a budgetary sense."

Some countries, such as Uganda, Senegal, and Thailand, have substantially reduced their rates of infection through prevention programs. However, "much more needs to be done," said Leach. Like Piot, he believes the United States should lead the world in eradication efforts: "U.S. financial support for medical research, education, and disease containment is far more than an expression of basic humanitarian concern. It's profoundly in our national interest."

Questions from the audience focused on timely and politically sensitive topics, such as stigma, homophobia, abstinence-only programs, the provision of antiretrovirals, and the effect of male circumcision on disease transmission. One audience member congratulated Piot for eschewing the typical pessimistic talk in favor of apprising people of the world's progress. Leach noted that Congress has only recently begun to address some sensitive issues surrounding AIDS, adding that discussions of once-taboo topics are now not only necessary but common. Piot stressed that there can be no ambivalence regarding the importance of HIV/AIDS in society and emphasized that "our reaction to having to face up to these longer-term demands should not be paralysis."

Drafted by Julie Doherty.