Closing every gap: The AIDS response Commonwealth Health Partnerships 2015 51 The AIDS response has been one of the most successful public health initiatives of the last 50 years. It unites science, communities, activists and policy-makers around a common cause. It unifies efforts to address a virus that has biomedical, social, legal and political ramifications. AIDS has always been about closing gaps: between stakeholders; between the general public and people on the margins; and between rich and poor countries. Today, almost 14 million people are receiving lifesaving HIV medicines. The number continues to increase by thousands every day and we are on track to provide antiretroviral therapy to 15 million people during 2015. In addition, we will have avoided 1.4 million deaths, prevented 500,000 HIV infections among children and protected seven million children from becoming orphans. This achievement will be our stepping-stone to reaching universal access and demonstrate that HIV treatment is a sound health and development investment that provides tangible returns. Universal access – to HIV services, to health care, to human rights – is essential, because whenever people are excluded, everyone loses. We will only achieve our goals if we ensure that we leave no one behind. To achieve this, universal health coverage (UHC) must actively address key social determinants of health: how people live, how they work, how they access and use services and resources. The AIDS response has successfully connected these divergent elements to deliver results for people, and provides important lessons as we strive to achieve UHC. One of those lessons is the critical importance of identifying and addressing the gaps in our programming and achievements to date. The recent UNAIDS Gap Report1 provided us with important lessons about the causes and solutions for people being left behind, using the best possible data. The report identifies a number of ‘gaps’ that are also instructive lessons for broader reflections on UHC and which I will briefly address below. Closing the investment gap In 2013 US$19.1 billion was available from all sources for the AIDS response, but the estimated annual need in 2015 is between $22 billion and $24 billion. Domestic investments from low- and middleincome countries (LMICs) accounted for around half of all HIV-related spending in 2013. Although this increase in domestic investment is a strong step in the right direction, we must also find innovative ways to diversify financing and find new ways of working. Today, 15 LMICs account for nearly 75 per cent of all people living with HIV. By strategically focusing HIV treatment and other proven prevention tools on key geographic settings and populations where rates of transmission and unmet need for HIV services are high, we can significantly reduce the rate of new infections and HIV-related deaths. UNAIDS has supported a paradigm shift by focusing not just on dollars but on shared responsibility and global solidarity, which takes us beyond simply raising and investing resources. It emphasised the critical importance of countries holding themselves and all related stakeholders (national and international) accountable to deliver on the commitments made for their AIDS response. We have seen tangible programmatic results in both Africa and the Caribbean from this shift. As a result, UNAIDS is now working with countries to develop financial sustainability transition plans that will not only take AIDS out of isolation, but also feature the lessons and resources of the AIDS response in ways that inform and influence in the broader health reform landscape. Closing the gaps in health and human rights Ensuring that no one is left behind necessitates closing the inequity gap between the people who can access services and the people who can’t; the people who are protected by our legal and social frameworks, and the people who are excluded. A key lesson from the AIDS response for our reflections on UHC is the importance of placing people at the centre of our approach. Global health and our concerns for UHC cannot only be focused on systems or pills – we must see these as tools to foster and promote human dignity. Our recent Gap Report highlights the multiple drivers of the epidemic that produce and perpetuate disparities and inequities in access and in coverage. Gender inequalities in particular – violence against women and girls, early marriage, lack of sexual and reproductive health services – cause women and girls to be disproportionally affected by HIV. Other drivers, like food insecurity and conflict, further block access to lifesaving services. The lessons of the AIDS response remind us that if we are to ensure universal coverage of services, human rights must be at the heart of health. It will be impossible to end AIDS – or achieve UHC – without respect for human rights and human dignity. This means ending discrimination and stigma, revisiting harmful or unhelpful laws and pushing for inclusiveness so that services and resources are available to all, ensuring that no one is left behind. Data and common sense support this conclusion: greater social security, gender equality and improved economic opportunities are strongly linked to HIV treatment compliance, reduced mortality, and lower rates of HIV acquisition and transmission. Left behind and overlooked Three decades of the AIDS response has highlighted vulnerable communities – predominantly LGBT (lesbian, gay, bisexual and transgender) people, sex workers, drug users, young people, and Michel Sidibé
Commonwealth Health Partnerships 2015
To see the actual publication please follow the link above