Accountability for Women’s and Children’s Health

World AIDS Day: Business Unusual: Time to end the AIDS epidemic

A statement from the independent Expert Review Group on Information and Accountability for Women's and Children's Health

Thirty years ago AIDS stole into our lives silently and ruthlessly decimating families as households incomes plummeted even as expenditures shot up and breadwinners succumbed to the collapse of their immune systems. As every sector in the economy was hit by mass morbidity and mortality resulting in absenteeism and lost productivity; food production fell, children lost teachers, health facilities lost their staff, and mining, manufacturing and service delivery deteriorated.

By the end of the past century, the devastation was staggering and the future looked bleak for many countries at the epicenter of the epidemic. 34.3 million people were living with HIV infection or suffering the crippling effects of AIDS and 18.8 million had died. Of these 5.4 million were infected in 1999, as 2.8 million died the same year. The toll on children was heart breaking and the orphan population stood at 13.2 million.

Given this alarming situation, the only strong response was from the people infected and affected by the nightmare. The world was experiencing a groundswell in civilian society demanding immediate action by countries and the international community. Nelson Mandela, when closing the Durban International AIDS conference made a clarion call!

"We need, and there is increasing evidence of, African resolve to fight this war. Others will not save us if we do not primarily commit ourselves. Let us, however, not underestimate the resources required to conduct this battle. Partnership with the international community is vital. A constant theme in all our messages has been that in this inter-dependent and globalized world, we have indeed again become the keepers of our brother and sister. That cannot be more graphically the case than in the common fight against HIV/AIDS."

This marked the beginning of the real concerted fight against the epidemic, as the civil society call was heeded with the subsequent creation of the Global Fund to fight HIV/AIDS TB and Malaria, and UNAIDS worked with countries to create national AIDS councils and comprehensive HIV/AIDS strategies.

Today though, the global outrage has declined considerably by several decibels, even though there are 35 million people living with HIV/AIDS with 2.1 million newly infected in 2013. Unfortunately AIDS is no longer considered urgent and is treated as a chronic illness in many countries despite the sad fact that 1.5 million people died of the infection in 2013 and the number of orphans has reached a staggering 17.8 million children under the age of 18 years.

Though there is progress, the epidemic still continues to be ahead of the fight and control is slipping out of our hands. Indeed 19 million HIV infected do not know their HIV status; fueling not just the spread of the deadly virus, but driving up the cost of the response, which stood at USD 19 billion in 2013.

It is time that the global community collectively committed to ending the epidemic once and for all. This will save countries from the continuing drain on their resources due to the constant loss of productivity and precious human capital. It will place an end date on the increasingly unaffordable escalating high cost of treatment, as country get more and more people qualifying for 2nd and third line treatment, even as those entering first line grow exponentially. It will give our children renewed hope not to be part of a second lost generation of AIDS orphans. It will put and end to the decimation of communities and entrenchment of poverty that has now become "acceptable" in affected communities. This will require a robust elimination plan including a financing plan and solid independent accountability to keep us on track.

There is now evidence that putting people on treatment early substantially reduces infection to near zero levels. The UNAIDS 2014 report calls for a global 90 90 90 goal by 2020 and 95 95 95 endgame by 2030. This would entail 90% of infected people knowing their status; 90% of those knowing their status on treatment; and 90% of those on treatment having suppressed viral loads enabling a critical mass of those infected to reach near zero transmission levels.

When these targets reach 95% in 2030, UNAIDS estimates that there will 200,000 new infections. UNAIDS refers to this approach as fast tracking the fight against AIDS. Unfortunately, we must be under no illusion that this is fast for the affected communities; by 2030, the nightmare have been feeding on their livelihoods for close to half a century!

We are entering an era; when overall wellbeing, poverty elimination, human rights, equity and universal coverage and access will define a new world order of sustainable development goals.

In line with this year's independent Expert Review Group report this vision will only be achieved if countries and the global community embrace the cycle of well being within the universal framework of human rights so critical to the fight against HIV infection and AIDS. A robust independent accountability framework must be developed, to support the Global strategy and operational and financing plan that accompanies this 95 95 95 vision. We cannot continue to do the same things and expect different results.

An AIDS free generation is possible, and long overdue! This is not fast tracking, it is business unusual, and it must happen now!!

Richard Horton (Co-Chair), Joy Phumaphi (Co-Chair), Carmen Barroso, Zulfiqar Bhutta, Kathleen Ferrier, Sejal Hathi, Dean Jamison, Tarek Meguid, Miriam Were

The iERG was established in 2012 as the principal global review group to monitor progress on the recommendations from the Commission on Information and Accountability for Women's and Children's Health. The iERG reports to the UN Secretary-General through the Director-General of WHO.