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The world's deadliest epidemic: 20 years & counting

December 1, 2001 · 


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


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