This year, which marks the 20th anniversary of World AIDS Day, also marks a major milestone in the long struggle against this disease. Well over 3 million people in low- and middle-income countries are now receiving life-prolonging antiretroviral therapy. Such an achievement was unthinkable 20 years ago, when the world was just beginning to comprehend the significance of this disease and its catastrophic impact on individuals, families, and societies.
AIDS is the most challenging and probably the most devastating infectious disease humanity has ever had to face. And humanity has faced this disease, in equally unprecedented ways. The international community has rallied at levels ranging from grass-roots movements to heads of state, from faith-based organizations and philanthropists to research institutions, academia, and industry.
On this 20th anniversary of World AIDS Day, I find it appropriate to reflect on some of these achievements. The response to AIDS changed the face of public health in profound ways, opening new options for dealing with multiple other health problems. It showed the power of determination to overcome seemingly insurmountable obstacles.
Civil society brought the disease – and the needs of those affected – to the forefront of world attention. Attitudes changed. Treatments were developed. Clinical schedules were streamlined and standardized. Funds were found. Prices dropped. Partnerships were formed, and presidents and prime ministers launched emergency plans.
The response to AIDS also reaffirmed some of the most important values and principles of public health. The AIDS epidemic showed the relevance of equity and universal access in a substantial way. With the advent of antiretroviral therapy, an ability to access medicines and services became equivalent to an ability to survive for many millions of people. The epidemic focused attention on the broad social determinants of health, the vital role of prevention, and the need for people-centred care. In so doing, it helped pave the way for a renewal of primary health care.
These achievements show the power of determination and global solidarity, but they also remind us of the challenges. I believe that the theme selected for this year’s World AIDS Day captures these challenges well.
Leadership is needed to ensure that vigilance and diligence in responding to the epidemic remain steadfast. Despite the global financial crisis, funding absolutely must remain predictable, sustainable, and substantial. We must ensure that the current unprecedented rollout of treatment reaches more people and is fully sustainable. Stepping back or slowing down on treatment is not an acceptable option on ethical and humanitarian grounds.
Empowerment is critical for an effective response, and most especially so for prevention. We must do much more to empower adolescent girls and women, both to protect themselves and to act as agents of change. We must work much harder to fight stigma and discrimination, which are huge obstacles to all forms of prevention, treatment, care, and support. In many countries, legal as well as social and cultural barriers prevent groups at risk from receiving the interventions and knowledge needed to reduce harmful behaviours.
Finally, we must deliver. In many countries, the weakness of health systems limits the ability to reach those in greatest need with sustainable services. I believe we now have an historic opportunity to align the agenda for responding to AIDS with the agenda for strengthening health systems. As noted in this year’s World Health Report, primary health care is the best way to operationalize a commitment to equity and social justice, to realize a focus on prevention, and to reach marginalized groups. These values and principles are the very foundation for the future of the AIDS response.
On this World AIDS Day, let us redouble our determination to build on past success and to rally our forces against the remaining obstacles – in a spirit of solidarity and for the sake of human dignity.