Defeating AIDS - advancing global health

Piot, P; Abdool Karim, SS; Hecht, R; Legido-Quigley, H; Buse, K; Stover, J; Resch, S; Ryckman, T; Møgedal, S; Dybul, M; Goosby, E; Watts, C; Kilonzo, N; McManusl, J; Sidibé, M The Lancet, 2015; www.sciencedirect.com/science/article/pii/S0140673615606584

This comprehensive report by UNAIDS and the Lancet Commission emphasises the importance of a structural response to the epidemic and references STRIVE’s work in this context.

The report is divided into two sections:

  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

Charlotte Watts, a STRIVE research director, is one of the co-authors of the report, together with Peter Piot, Director of the London School of Hygiene & Tropical Medicine, who provides guidance to the consortium.

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 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

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.

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.

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