Mural in San Francisco

UNAIDS and The Lancet release major report

29 June 2015
Michelle Moore & Annie Holmes

STRIVE's work on structural drivers is referenced at high-profile London event.

Launching this landmark publication – Defeating AIDS: Advancing Global Health – the Chairperson of the UNAIDS and Lancet Commission, Professor Peter Piot, highlighted the importance of a structural response to the epidemic in general and STRIVE’s work in particular. STRIVE Co-research Director, Professor Charlotte Watts, is one of the report’s co-authors. 

Among the report chairpersons and commissioners attending the half-day event at the London School of Hygiene & Tropical Medicine (LSHTM) were Dr Nkosazana Dlamini Zuma, Chairperson of the Commission of the African Union, and activist and singer/songwriter Annie Lennox. The audience heard from a number of key actors in the HIV field, organised in two panels as per the two sections of the report:

  1. Defeating AIDS – the state of knowledge about the epidemic and strategies for overcoming it
  2. Advancing Global Health – what it means to integrate and learn from HIV within a new vision for global health

The importance of a structural approach

Overall, the report establishes a structural approach and emphasis on social determinants as central to the field, in tandem with biomedical and behavioural interventions. In the transition to the Sustainable Development Goals (SDGs), the relevance of STRIVE’s agenda is gaining increasing recognition, as witness to the first and last of the report’s seven key recommendations:

  • Get serious about HIV prevention - including combination prevention - and continue the expansion of access to treatment, while also working to address structural determinants of health that put people at risk
  • Promote more inclusive, coherent, and accountable AIDS and health governance; establish a multi-stakeholder, multi-sector platform to address determinants of health

Salim S Abdool Karim presentation

A slide from Professor Salim S. Abdool Karim’s presentation underscores the urgency of addressing the HIV risk faced by adolescent girls in sub-Saharan Africa. Among pregnant girls under 16 years of age in South Africa, one in ten is HIV positive. Under 24 years of age, one in two is HIV positive.

Progress is unprecedented but gains are fragile

The report’s principal findings about the global AIDS situation are sobering. Maintaining current levels of investment in treatment would not only be inadequate, the authors conclude: "even standing still on HIV means going backwards." Meanwhile, prevention efforts do not reach many within at-risk populations. As a result, rates of infection and mortality continue to be high and, according to modelling, will rise.

International HIV commitments from donor governments

Conversely, however, the field has made extraordinary gains, charting a path for global health more broadly. The report outlines the strategic steps necessary to sustain and advance these gains, including a human-rights approach in order to challenge stigma and ensure universal access. The SDGs could provide the framework within which to integrate an accelerated HIV response while applying the lessons from AIDS across health and development.

Median age at death South Africa

 

Quotes to remember 

If the most is made of this five-year window of opportunity, HIV transmission and AIDS-related deaths could be greatly reduced and mother-to-child transmission virtually eliminated by 2030. … Inclusion is the key to ending the AIDS epidemic by 2030. 

Michel Sidibé, Executive Director of UNAIDS and Co-Convenor of the Commission

 

If you need facts, here they are. We are not even halfway to ending AIDS. 

Professor Salim S. Abdool Karim, CAPRISA, and Chair, UNAIDS Scientific Expert Panel 

 

I do believe this report is honest. I see the most hard-to-reach individuals in it and their challenges. Let’s put these words into action. An action we can measure. 

Cristina Jade Peña, Ambassador for Elizabeth Glaser Pediatric AIDS Foundation  

 

Change is driven by people. Structural barriers, politics and power limit implementation. 

Dr Sigrun Mogedal, Norwegian Knowledge Centre for the Health Services

 

The AIDS response must continue to be grounded in human rights. Practical solutions are needed to expedite changes in the laws, policies and attitudes that violate the rights of vulnerable populations, and that stand in the way of an effective AIDS response. 

Dr Richard Horton, Lancet Editor-in-Chief and Co-Convenor of the Commission

 

What we need is a coalition of the daring. 

Pascal Lamy, former European Commissioner and former Director-General, WTO  

Resources

Cover photo credit: Peter Piot