The world's deadliest epidemic: 20 years & counting
TWENTY YEARS AGO in June1981, the first official report of the disease now
known as AIDS was made in a nine-paragraph report of the U.S. Centres for
Disease Control. Five people were affected.
No one reading those nine paragraphs could know that they were looking at what would become the most devastating epidemic in human history. It was inconceivable that HIV would spread so rapidly that within the first 20 years of the epidemic it would infect 58 million people, killing 22 million of them.
I will never forget the day in 1983 when I revisited Kinshasa's large Mama
Yemo Hospital, a place I had come to know during the Ebola outbreak in 1976.
When I saw the large numbers of emaciated young men and women, I instantly
realised that the world would face a major new epidemic-one driven by sex.
Even so, none of us involved in those early days of AIDS could have imagined
the scale of the epidemic that has unfolded.
For all the destruction the
virus has already caused, we are still at the early stages of the epidemic
It is a tale of globalisation: of the rapid global spread of a mainly
sexually transmitted virus, of global inequities in health, and of the need
for a truly global response and solution.
And it is a tale that is still in its opening chapters. HIV is characterised
by a relatively long gap between infec tion and major illness. Its natural
dynamic is to show up first among those at heightened risk, while at the
same time gradually moving across the whole of the sexually active
population. So one of the hardest lessons is that, for all the destruction
the virus has already cause, we are atill at the early stages of the
epidemic.
But that does not mean that we have no choice but succumb to an inevitably
growing toll of the disease. The opposite is true. The course the epidemic
takes over the next 20 years will be a consequence of the choices the world
makes now.
The brief history of AIDS is on eof evolving understandings and shifting
paradigms – from a medical curiousity to a complex hrealth issue with major
development, political and human security dimensions.
This year, the global response to AIDS is opccuring in a rapically new
context. First, there is a convergence of scientific, economic and policy
thought on the question of resources. Demending billions of dollars for the
wprld has moved from being a naïve plea to a political imerpative.
New paradigm
Second, access to a wider range of HIV care has moved from the realm of the
impossible to the possible. For years, the price of drugs seemed to be an
impossible barrier. But today, preferential prices for developing countries
for AIDS drugs has been widely accepted within both the pharmaceutical
industry and by policymakers.
In this new context, consensus is growing around a new paradigm.
First, investment now will prevent tens of millions of new infections and
extend the lives of millions already living with HIV.
Second, whatever the stage of the epidemic, special recognition of the needs
of young people maximises the effectiveness and impact of prevention.
Third, prevention, medical treatment and social support are all critical
components of effective responses. Their effectiveness is immeasurably
increased when they are used together
Fourth, while the degree to which poor countries are able to extend access
to antiretroviral therapy varies, in every case a beginning can be made. But
these treatments have to be used carefully if they are to have lasting
benefits, given that even under the best-resourced and most closely
monitored conditions, the virus develops resistance to these drugs.
Prevention and treatment
And fifth, political commitment and planning exists in many countries around
the world to build on existing programmes to greatly scale up prevention and
treatment. What they lack are the resources.
The benchmark cost of providing a prevention and care response to the
epidemic in low- and middle-income countries is US$7 to US$10 billion. There
is a big gap between this figure and current AIDS spending from private,
national and international sources in these countries of fewer than US$2
billion.
Filling this gap will undoubtedly need a greater level of commitment from
national budgets.That is one reason why liberating funds through debt relief
is a valuable part of HIV responses. As well, private sector involvement, in
workplace and community responses to HIV, is another source of support.
But as well as building up these channels of support, meeting the resources
gap will need a new global fund, attracting genuinely new money, from both
wealthy country governments and from private donors.
To this end, a Global AIDS and Health fund, as called for by UN
Secretary-General Kofi Annan in April of this year, is rapidly taking shape.
Already, more than US$1.5 billion has been pledged to the fund. These
resources must provide for a wide spectrum of efforts, from supporting
prevention programs, to increasing access to care and building the
healthcare infrastructure that is sorely lacking in much of the world.
For the first time in the history of this epidemic we have the opportunity
to turn the tide on a truly large scale-the scale that matches the extent of
the epidemic.
We know what we need to do in order to slow new infections
and Provide care for those who are ill
The stars are moving into the right configurations: we know what works,
there is a strategy, there is political commitment, and resources are
coming. There are still some stars missing-the ones with the vaccine and an
effective microbicide that kills HIV on contact, as well as the one with the
all out effort to eradicate the stigma associated with AIDS.
Special Session
In June, the United Nations General Assembly held its Special Session on
HIV/AIDS. That Session, and the Declaration of Commitment it endorsed
unanimously, showed that the nations of the world are prepared to
demonstrate the resolve and the vision necessary to turn back the epidemic.
Now is the time for these commitments to be made good, and for detailed
programmes across nations and regions to the global targets set by the
session. Preeminent among them are the commitments that by 2010, HIV among
young people globally will be reduced by a quarter, and the number of
infants infected with HIV will fall by half.
We know what we need to do in order to slow new infections and provide care for those who are ill. The only question is whether we have the will to do it.
Dr. Peter Piot is Executive Director of the Joint United Nations Programme
on AIDS (UNAIDS)
