An answer to Aids

The underlying principles of solidarity and awareness have remain the same throughout the 20 years of World AIDS Day, write Michael Cashman, Anne van Lancker and Martijn Pakker

December 1 2008 marks the 20th anniversary of World AIDS Day. For over twenty-five years, the HIV/AIDS pandemic has been affecting the lives of millions, having a devastating impact on individuals, families, communities, society and economies.

With the current technical and medical advances, HIV infection has shifted from being a death sentence to a chronic disease. As with any chronic disease, a correct and timely follow up is necessary to ensure that a person can access the appropriate care and treatment. However, over 70 per cent of HIV-positive people, in particular in Africa, still can’t access antiretroviral treatment.

In 1988, health ministers from around the world met and agreed to mark this day as an opportunity for the global community to demonstrate their solidarity in the response to HIV and AIDS. To this day, this underlying principles of solidarity and awareness remain the same. Each year, World AIDS Day follows a theme.

Last year the message was to “Keep the Promise”, a message to governments and civil society alike to remind them of the commitments made and – more importantly – the importance of keeping these commitments and scaling up to ensure an adequate response to the pandemic. So where have we got to?

Since scientists identified HIV as the catalyst for AIDS in the eighties, the face and response to the pandemic have greatly changed from primarily concentrated epidemics among high-risk groups to more generalised epidemics.

Despite the increased efforts and progress made to prevent further spreading of the virus, a lot remains to be done: well-intended national policies lack adequate funding and implementation, the rate of new infections is nearly three times higher than available treatment, and legal protection against stigma and discrimination continues to be a major threat to universal access.

The call for leadership has been answered by governments and civil society alike. Much of the best leadership on AIDS has been demonstrated within civil society organisations challenging the status quo.

It is now crucial to scale up these leadership efforts to address the ever-increasing need for a comprehensive response to the pandemic. National governments must also take on their leadership role in living up to their commitments, within existing financial mechanisms as well as in innovative financing mechanisms. Promises must be kept, and people must feel empowered to act.

Communities lie at the heart of the response to the pandemic. They play a vital role in providing care and support for those living with, or affected by, HIV.

By involving and empowering communities of those most vulnerable, be they women, adolescents, sex workers, people who use drugs, or the lesbian, gay, bisexual and transgender community, it is critical to ensure their active participation in dealing with the issues that are relevant to them. By implementing and promoting comprehensive national policies, including legal and human rights protection, these communities will be empowered to take control of their situation.

Most importantly, the delivery of concrete measures to halt the spread of HIV, such as the availability of prevention methods such as condoms (male and female) and further research into new prevention technologies such as vaccines and microbicides are imperative to a successful global response to the epidemic.

This World AIDS Day, if we are serious about achieving the internationally agreed goal to “achieve universal access to comprehensive [HIV] prevention programmes, treatment, care and support by 2010”, action is needed now to lead, empower and deliver.

Developing an effective, affordable AIDS vaccine is a major challenge, but one that can be met if we can enhance the capacity of developing nations, says Frans van den Boom

In Bamako, Mali on November 17, governments from around the world met to discuss priorities for promoting health research.

I had the pleasure of attending this event and discussing how international research for new medicines and vaccines contributes to reaching the Millennium Development Goals.

Let’s take AIDS as an example. Few diseases have threatened economic development quite as seriously as has this disease. Sub-Saharan Africa accounts for about 75 per cent of all AIDS-related deaths, and the people felled by the disease there, as elsewhere, are typically in the most productive periods of their lives.

They are teachers, nurses, technicians, farmers, mothers and fathers in their prime. Their deaths fray the fabric of developing economies and leave gaping holes in the social networks that sustain society.

Over the past decade, global commitments to tackle the AIDS crisis have grown substantially. But more than twenty-five years into the pandemic, the disease remains incurable. So prevention should be a priority, and no tool is more powerful at preventing infectious diseases than a vaccine.

The promise of this tool is perhaps best exemplified by polio, a disease that has virtually been eliminated from this planet with the help of a preventive vaccine. We stand an excellent chance of halting the spread of HIV and ending AIDS if we can develop a safe, effective and affordable AIDS vaccine.

Developing this vaccine is a major challenge, and it won’t be achieved without the concerted effort of scientists and researchers around the world. I am particularly convinced that we must actively seek to involve and support the researchers and scientists from developing nations in this enterprise.

After all, such countries account for upwards of 95 per cent of new HIV infections. Any technology devised to turn the tide of the AIDS pandemic will have to be tested within their borders.

It is, therefore, imperative that we invest in the long-term scientific capacity of developing nations. We need to train their researchers, open career paths for them and collaborate with them to develop new preventive technologies against HIV.

By doing so, we not only ensure the sustainability of the AIDS vaccine effort We also help to reverse the brain-drain that has sapped so many developing nations of the very talent they need to tackle their public health challenges and power their economic advancement.

Indeed, those countries that are disproportionately affected by preventable diseases often lack the technical know-how and financial resources required to develop the drugs and vaccines they need.

Meanwhile, private companies, though well-equipped to develop such interventions, have little incentive to assume the high risk and cost of addressing the health problems of the developing world.

Public-Private Partnerships for Product Development have in recent years played a major role in bridging this divide. These unique partnerships tap the public sector’s commitment to supporting worthy, if unprofitable, causes to draw the private sector into efforts to combat neglected diseases, primarily by alleviating the financial risk associated with taking on such challenges.

Additionally, these organizations have established extensive and lasting research networks that cross the north-south divide.

Developing an AIDS vaccine has proved more difficult than we imagined when we first set out on our mission decades ago. But we take heart in knowing that the mission is vital and that the pursuit of such an agenda can have a lasting, positive impact long before the goal is accomplished.