HIV and AIDS, Health and Development

29 Jul 2012

HIV and AIDS, Health and Development: Who owns the AIDS response? By Melissa Sobers, UNAIDS, and Mariana Mansur, UNDP.

Recently there have been two landmark global events which sought to reaffirm the commitment to ending the HIV epidemic and its impact on individual, national and global well-being. The first was the High Level Meeting (HLM) on HIV/AIDS that took place in New York on June 8-10, 2011, with a Belizean delegation led by the Minister of Health, Honourable Pablo Marin, accompanied by the First Lady Kim Barrow, other government officials, as well as representatives from the civil society organizations. The second one was the Sixth International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention that took place in Rome from July 17-20, 2011. Although the two historical conferences took different approaches, the first political and the second scientific, the main outcomes from both meetings have both global and national convergent implications.

The first case of the Human Immunodeficiency Virus (HIV) in Belize was discovered in 1986 and since then over 5,000 cases has been reported. With the highest adult HIV prevalence rate in Central America and the fourth highest in the Caribbean, the epidemic is still of crucial concern for Belize. Notwithstanding this, significant progress has been made, as Belize continues to see reduction in the incidence rates, with a greater than 25% decrease in the past three years. If we are to positively impact the adult HIV prevalence rate in Belize, decision makers must pay attention to policies and laws that impede access to services, consolidate the advances in the prevention of mother to child transmission, ensure that those most vulnerable to HIV infection, including young people, men who have sex with men, sex workers and prisoners have access to prevention programmes, continue the scale up of effective treatment options for people living with HIV, and a definitive move to the production and use of strategic information on HIV in Belize.

Thirty years into the epidemic of HIV, which posed major challenges for public health control, we see a revolutionizing of how to manage and control epidemics, particularly in developed countries. Today we can confirm significant advances, despite the challenges we are facing in some countries. It has been very clearly said by all the global leaders that “The control on the epidemic is not only a responsibility of the public health system, this is a common shared multi-sector response, that needs to be well targeted and oriented to the most vulnerable to HIV infection”.

One exciting new advance is the game-changer – treatment as prevention. In May 2011, the most significant trial results seen to date in the AIDS response were released. It showed that if an HIV–positive person adheres to an effective antiretroviral (ARV) therapy regimen, the risk of transmitting the virus to their uninfected sexual partner can be reduced by 96%. At the HLM in June, based on the results of clinical trials, governments agreed to a bold target of expanding effective antiretroviral treatment to reach 15 million of those in need by 2015. In 2003, the government of Belize launched free HIV treatment programme, which can be accessed by all in need of ARVs. Despite such gains there is still need for the country to scale up this goal to increase the uptake of testing for HIV, providing efficient and effective treatment regimens, as well as exploring the use of point-of-care technologies, which enable decentralization and expansion of CD4 and viral load testing into the primary health care system.

The world’s largest open scientific conference on HIV/AIDS, the Sixth International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention opened in Rome last July. It focused on the latest biomedical research and advances for HIV and its application for treatment and prevention. The results were encouraging showing that in the last two years there have being significant biomedical advances, unlike any seen since the antiretroviral breakthroughs of the mid-1990s. Scientists discussed strategies around such topics as the path towards a cure and the encouraging signs on HIV vaccines in a very near and real future. But the key challenge will be how to make these breakthroughs available in such a way that they have a real impact when brought to scale, and how countries can implement them in a sustainable way. Michel Sidibé, the Executive Director of UNAIDS expressed that history will judge us not by our scientific achievements, but how we apply them. Expanding treatment needs to be considered as a prevention strategy, but the cost associated needs to be accounted for. We must consider the investments we make now as down payments that will reduce cost later.

While the HIV epidemic is not over, we all recognize the enormous successes over the past decade in boosting prevention and treatment around the globe. In Belize, as the efforts continue to be consolidated and we seek to maintain the gains made, it is essential that we keep three goals in mind:

  • An effective and sustainable multi-sector response to HIV/AIDS that addresses human rights and development issues along with the health sector response. Integration of HIV and sexual and reproductive health services into the primary health care system becomes imperative. A response encapsulated by good governance and mutual accountability by all stakeholders, while ensuring that the HIV/AIDS response expands beyond a stand-alone health services delivery initiative.
  • Intensifying efforts to end new HIV infections, while creating an enabling environment for scale up of diagnosis, treatment and care, including using revolutionary strategies targeted to those most vulnerable to infection and those who lack the means to access services. These groups, such as women and girls living in poverty, low-income migrants, unemployed young people, ethnic and sexual minorities, drug users, and prisoners, are often the same people marginalized by other barriers, such as the socio-economic, to access health services.
  • Visualizing HIV as a development issue and focusing on multiple impacts interventions. It is imperative that we understand the interactions of HIV and poverty, gender inequalities, education and other social and economic structural determinants of development. Our work must take on a multi-faceted approach, such as, when working with women we can simultaneously promote gender equality, lower HIV risk, improve sexual and reproductive health, and increase women’s participation in the work force.

At this pivotal juncture in time, as the world refocuses for a renewed thrust to ending the epidemic, we in Belize must continue to look critically, base our interventions on hard evidence, and provide universal access to HIV prevention, treatment and care by 2015. Coupled with the aim of targeting interventions and focusing resources where they are most required, there is still a common and shared responsibility that needs to be translated from goals into tangible and sustainable actions and results. As we share successes, we must also have a sense of shared responsibility and mutual accountability if our goal is to end AIDS within the decade, a vision of zero new infections, zero AIDS-related deaths and zero stigma and discrimination.