It was reassuring in today’s plenary at the 20th International AIDS Conference in Melbourne, to hear Mark Dybul, former US Global AIDS Coordinator and now Executive Director of the Global Fund, walk the audience through the tremendous achievements the global community has made in fighting HIV/AIDS over the last decade or so and remarking that the question now is not whether we can defeat AIDS but whether we will do it!
In other words, we have in our midst an armamentarium already powerful enough not only to reverse the HIV epidemic but actually to defeat it. The key question is whether we can address the mainly structural barriers such as poverty, cultural norms, and gender inequities that continue to persist in the most affected regions in the world.
We know that treatment as prevention is highly efficacious, yet less than half of those that need antiretroviral therapy in sub-Saharan Africa are receiving it; we know that voluntary medical male circumcision (VMMC) if scaled up to at least 80% of males aged 15-54 in the most highly HIV burdened countries will be a powerful tool for prevention – recent evidence even suggests that its effectiveness increases with time and, as a once-off procedure that provides lifetime protection, it is a cost effective way of prevention in the long term. We also know that providing a cocktail of highly efficacious antiretroviral drugs to all pregnant women who are HIV positive will go a long way to virtually eliminating mother-to-child transmission and we are aware that pre-exposure prophylaxis (PrEP), especially if utilized in most high risk groups, has proven to be an effective HIV preventative tool too.
We can now map out most-at-risk populations and know that even in countries with generalized HIV epidemics there are many ‘hotspots’ with sub-epidemics that continue to fuel HIV spread in the general population.
Despite all these tools and our knowledge, HIV continues to thrive in some sub-groups or key populations. We know that adolescents, especially girls, are particularly vulnerable and in many countries have an HIV prevalence many times higher than their male peers. We also know that several countries have recently enacted retrogressive laws that may prevent key populations from seeking much needed diagnosis, care, and treatment for HIV.
We are now at a ‘tipping point’ and what direction we decide to take at this crucial moment in history will determine whether we can make the HIV epidemic history or leave it to linger on for generations to come.
As we seek to get an ‘AIDS-free generation’ – something tantalizingly within our reach, the time to act is now and ensure that we provide the right tailored solutions to the right problems in various contextual settings and leave no one behind!