HIV/AIDS: Universal action now
Dr Margaret Chan
Director-General of the World Health Organization
Friends, colleagues, ladies and gentlemen,
As Dr Piot and others have noted, we are at a critical stage, a new phase, in our efforts to combat the HIV/AIDS epidemic.
The current situation is assessed in the new UNAIDS report, which points to some milestone achievements, but also underscores the enormous challenges that lie ahead.
Let me take this opportunity to express my personal gratitude to Dr Piot for the leadership he has shown since the very beginning of this epidemic.
AIDS is the most complex, the most challenging, and probably the most devastating infectious disease humanity has ever had to face. And we have faced this disease, head on. We have rallied.
Since the beginning, the response has been led by the courage, determination, and vision of civil society and the advocacy of activists, and I thank them. The rallying point was straightforward: something must be done.
The history of the response has been one of demanding action, identifying obstacles, and unleashing the power to push these obstacles aside. The activists set things sailing. The international community stepped in to build the boat. This is global solidarity.
The AIDS response expanded the frontiers of public health and showed the power of a can-do attitude. It changed the face of public health in profound ways, opening new options for dealing with multiple other health problems.
Treatments can be found. Prices can drop. Funds can be secured. Services can be delivered in resource-constrained settings. Attitudes can change. With sufficient will, commitment, and resources, a bleak and depressing situation can be transformed into one of optimism and hope.
In this regard, let me join others in expressing appreciation for the renewal of the US President’s Emergency Plan for AIDS Relief.
Above all, a commitment to universal access is an expression of respect for the value of each and every life affected by this disease. This, too, is a monumental achievement.
Ladies and gentlemen,
Let me turn from an appreciation of achievements to focus on the obstacles that lie ahead. We have cause for optimism, but we dare not let down our guard. This is an unforgiving epidemic that can strike back in surprising, sometimes startling ways. The epidemic is not over. We are in this for the long haul.
First and foremost, we must do a much better job of prevention. This is the only way to get ahead and ensure an adequate long-term response. We urgently need to scale up the use of proven context-specific prevention methods. We also need to expand linkages between sectors – for example, to introduce and scale up comprehensive sexuality education for young people.
In this regard, I wish to commend the successful outcomes of the First Inter-ministerial Meeting of the Latin American and Caribbean Ministers of Health and Education. I thank the Mexican government for convening this brave initiative.
Second, we must work much harder to fight stigma and discrimination, including institutionalized discrimination. 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. We must also do more to empower women, both to protect themselves and to act as agents of change.
Third, we must ensure that the current, unprecedented rollout of treatment reaches more people and is fully sustainable. The 3 by 5 initiative, with its can-do approach, paved the way for an even greater commitment to universal access. Nearly three million people in low- and middle-income countries have seen their lives rejuvenated by these treatments. Stepping back or slowing down on treatment is not an acceptable option. It is not ethical.
Fourth, we must be very smart in targeting interventions. With the evidence and experience gleaned over almost three decades, we now face an unprecedented opportunity to mount a mature response to this epidemic. This is reflected in the theme for this conference: universal action now.
We have proven tools and strategies for preventing every mode of transmission and for expanding treatment coverage. To take advantage of this opportunity, we must recognize that we are not facing a single, uniform global epidemic. We are facing a diversity of different epidemics with distinct profiles and distinct needs for intervention.
Recognition of these differences helps craft sharply targeted strategies for every major at-risk and vulnerable population. Doing so helps produce the best results and best return on investments.
In the interest of facilitating a sustained AIDS response, we must look for every opportunity to improve operational efficiency. One way to do so is to make linkages with existing health services – for example, for youth, mothers, and children, for sexual and reproductive health, and for reaching out to men who have sex with men, sex workers and injecting drug users.
Above all, we must do our utmost to integrate HIV/AIDS services with those for TB. Giving attention to TB is part of the urgent need to address the AIDS epidemic in Africa, which bears by far the greatest burden of these mutually reinforcing diseases.
Finally, a mature response to this epidemic must remember every lesson. One disturbing trend is occurring. This is the resurgence of the epidemic in men who have sex with men. This is occurring right here, in the Americas as in other parts of the world.
This is a setback in a group that pioneered the earliest response to this disease. As I said, we must remember every lesson.
Ladies and gentlemen,
At this particular stage in the epidemic, I find it most appropriate that the conference is hosted in Latin America. Many countries in this region have a long tradition of embracing the principle of equitable access to health care as a fundamental human right. The future of the AIDS response rests on this foundation.
In addition, countries in this region have been steadfast in their commitment to primary health care as the best way to operationalize a wider commitment to equity and social justice.
The response to HIV/AIDS, and most especially the massive rollout of treatment, have brought into sharp focus the consequences of decades of failure to invest in basic health infrastructures.
We should not blame disease-specific programmes for weakening the health system. The truth is that for decades, governments have underinvested in health infrastructure. Further sustainable progress depends absolutely on improved service capacity.
At this stage, we have an historical opportunity to align the agenda for responding to AIDS with the agenda for strengthening health systems. I would further argue that the best way to do so is through a primary health care approach.
The two agendas are not in conflict. They are mutually reinforcing. A primary health care approach gives priority to at-risk and vulnerable populations. The pursuit of equity, social justice, and universal access is its driving force. This is an inclusive approach that encourages community participation and ownership, including ownership by people living with HIV.
Primary health care places prevention on a par with treatment and care. It recognizes that actions in multiple sectors influence health, and solicits their support. And it is built for the purpose of a sustainable response.
If the response to AIDS can be used to strengthen primary health care, this will be another great legacy that benefits all of public health.
If the response to AIDS can be used to strengthen primary health care, this will be another proof of the unstoppable power of a must-do, can-do approach to universal action – now and more than ever.