As we mark World AIDS Day today, those dedicated to controlling and ending the HIV epidemic find themselves in a fortunate position. We know what to do next—and that is stay the course. That doesn’t mean we can be complacent. Every day, about 5,000 people are newly infected. About nine percent of them 14 or younger. Worldwide, about 36.7 million people are living with HIV.
Finding hope in daunting statistics
JSI is a long-standing member of the community pushing back against this picture. Through collaborative efforts with national and district governments, NGOs, and the private sector, we support scale-up of innovative prevention, treatment, and care strategies, such as test and treat, HIV self-testing, and PrEP, and integrate them into existing systems. We manage the Strengthening High-Impact Interventions for an AIDS-free Generation (AIDSFree) Project, DREAMS Innovation Challenge Fund, and numerous country-specific programs that are funded through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and targeted U.S.-based national, state, and local HIV programs.
This year’s World AIDS Day theme, Increasing Impact through Transparency, Accountability, and Partnerships, helps us find the good news in those seemingly grim HIV statistics. A careful analysis shows that the number of new infections, while still unacceptably high, declined by 11 percent between 2010 and 2016. The number of people living with HIV who had access to life-saving medicines rose from just 685,000 in 2000 to 20.9 million in 2017.
The transformation of an epidemic explained
Digging deeper into the numbers explains the transformation of the face of the epidemic. For the decline generally and for groups with the steepest drops in new infections, the explanation is the smart and aggressive use of antiretroviral therapy. Among children, new infections have declined 47 percent since 2010. During the same time, the use of antiretroviral medicine among pregnant women living with HIV (to prevent transmission of the virus to their children) rose from 47 percent to 76 percent.
In turn, we know what drives this extraordinary expansion of antiretroviral therapy. PEPFAR, a bipartisan initiative first proposed by President George W. Bush in January 2003, is the largest commitment by any nation to address a single disease in the world. The scale of the epidemic demands nothing less. Our job is to make our progress, our real successes in fighting HIV, visible and transparent not only to ourselves but also to the larger community and the donors like PEPFAR who make our fight possible.
PEPFAR is a program that continues to make an impact; any cuts to the program will only result in a reduction in the number of people accessing HIV prevention, care, and treatment. Even while we discuss the hope in how many PLHIV are now accessing medicine, we may run the risk of losing those gains if we begin to narrow our focus. According to the United Nations AIDS Programme, in Eastern Europe and Central Asia, which have not expanded health and HIV services to key affected areas, new HIV infections have risen by 60 percent since 2010 and AIDS-related deaths by 27 percent. PEPFAR has also been the voice for key populations including men who have sex with men, sex workers, transgender people, and people who inject drugs in many countries where there has been no government voice. Without this voice, there will be a political and financial vacuum in terms of HIV programming in many key countries throughout sub-Saharan Africa.
PEPFAR plays a less well-known but critically important role in responding to and integrating innovation in HIV prevention and care. That role is particularly valuable in PMTCT, VMMC, and test and start. PEPFAR is only going to be more important in the future as we identify better tools, such as long-acting treatment and injectable PrEP. Cuts today will seriously undermine the response for years to come.
Although we find that we are under constraints to balance our national budget, we must refrain from dipping into a program we should all take pride in and one that makes an impact that reverberates throughout the world. One of the US government agencies responsible for administering PEPFAR, the U.S. Agency for International Development, puts it more bluntly and states without qualification, “The end of HIV/AIDS as a public health threat is finally in sight.” We know that we are on the precipice of having the technology to meet epidemic control in a majority of countries in a relatively small amount of time. The end of HIV is in sight, we must hold the line and continue to support PEPFAR until all of our children and young people are no longer testing positive.