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Ending AIDS Requires Strategy, Funding

In this photo taken Sunday, Nov. 9, 2014, a dozen children perform a traditional courtship dance from eastern Uganda as part of a platform for changing attitudes among youth using dance, drama and popular hip hop music, at the Treasure Life Center in the Kamwokya slum of Kampala, Uganda. As World AIDS Day is marked on Dec. 1, Uganda and many other African countries are continuing their battle against HIV and AIDS, and Ugandan street activists like 26-year-old Hood Katende are trying to use music and drama to stem a troubling resurgence of HIV, which now infects more than 500 young women between the ages of 15 and 24 each week, according to the Uganda AIDS Commission. (AP Photo/Rebecca Vassie)

December 1, is World AIDS Day. In the 35 years of the epidemic, about 80 million people have become infected with HIV and nearly 40 million have died. But great progress has been made in recent years in preventing and treating the disease. UNAIDS – the Joint United Nations Program on HIV/AIDS – has set a goal of ending the epidemic by 2030. An advocacy group says a strategic plan and much funding are needed to achieve that goal.

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In a video taped message for World AIDS Day, UNAIDS Executive Director Michel Sidibe asked people to reflect on the lives lost to Ebola.

He said, “Ebola reminds us what we were going through at the beginning of the fighting against HIV. People were hiding themselves. They were scared. Stigma, discrimination. We were not having any hope.”

Sidibe said that “thanks to global solidarity, social mobilization and civil society activism, tragedy has been turned into opportunity.” He said that the lives of millions of people infected with HIV have been saved due to greater access to antiretroviral drugs.

UNAIDS has – what it calls -- a fast-track strategy to end the epidemic by 2030. The first phase sets targets for the year 2020 known as 90-90-90.

Mitchell Warren, executive director of the HIV advocacy group AVAC, said, “Coming out of the AIDS conference this year in Melbourne, Australia, UNAIDS talked about this goal of getting 90 percent of people, who are infected with HIV, to know their status – 90 percent of them to get on treatment – and 90 percent of those on treatment to be – what we call – virologically suppressed. That the antiretroviral drugs would suppress the virus.”

Research shows the more HIV is suppressed in the body, the less likely a person is to infect someone else.

“That’s really great news, but if you do the math – going from 90, 90, 90 – it works out to about 73 percent of people, who are infected, would need to be virologically suppressed. But keep in mind that even in the United States right now less than 30 percent of people who are infected are virologically suppressed. So, there’s a huge amount of effort to translate this kind of rhetoric – this good idea of 90, 90, 90 – into practice,” he said.

Warren warned that treatment alone won’t be enough to make 90-90-90 a reality.

“One of the points that AVAC brings up in our AVAC report is called HIV Prevention on the Line. Because to get us truly to zero new infections in the long term, which is the ultimate goal, is going to require prevention. So to get on that line to zero we need HIV prevention. But that title also carries a double meaning. Because right now given all of this focus on 90,90,90, we believe that HIV prevention is actually in jeopardy.”

The AVAC leader said prevention should be given greater emphasis in the UNAIDS strategy.

“We need to be sure that we have very clear targets and resources and programs that keep prevention high on the priority along with treatment so that we actually can think about ending this epidemic,” he said.

Warren added that ambitious plans like 90, 90, 90 can cost a lot of money.

“Unfortunately, the funding is not there. And I think that’s probably the most important reality check here at World AIDS Day. So, we are at real risk of setting targets that aren’t resourced and therefore those targets could be unmet simply by the incredible resource gap at the global level. So, we have these amazing opportunities to have impact on the epidemic, but it doesn’t come for free.”

He said knowledge gained during the HIV/AIDS epidemic can be applied to West Africa’s Ebola crisis. Both diseases have bred fear and discrimination.

“Having a clear human rights based response is just as important as having a good public health response. And that’s lesson number one. Lesson number two is that while we do all the important work of caring and treating for people, having a research agenda is critical. And the third important lesson I think that draws a connection between HIV and Ebola is that strong public health systems are critical for any infectious disease,” he said.

Nigerian health officials said that a big reason it quickly ended its Ebola outbreak was the health infrastructure that had been set-up to deal with polio and HIV.