The imperative of US leadership: Fast-tracking the end of AIDS

After more than a decade of remarkable leadership by the United States in the response to HIV, we have a unique opportunity to end the AIDS epidemic. By fast-tracking the AIDS response today, we can realize one of the greatest humanitarian triumphs of the 21st century—ending the AIDS epidemic as a major public health threat by 2030.  

Even before history is written, the story of the United States’ role is clear. No other nation has invested more generously in the AIDS response. America’s commitment and action, led by presidents George W. Bush and Barack Obama, has literally saved millions of lives. 

{mosads}In the past several years alone, a vast global health alliance has been forged. Country after country has seen the power and the results of the shared responsibility and global solidarity model. Scientific advances combined with smarter investments and effective strategies have rapidly decreased the number of new HIV infections and AIDS-related deaths and have put us on course to an AIDS-free generation. Investments in health systems have strengthened basic infrastructure which has allowed some countries to rapidly contain the Ebola epidemic still spreading in parts of West Africa.  Thanks to the power of these combined investments, we have bent the trajectory of the AIDS epidemic. Now we have a fragile five-year window to break the epidemic for good, or we risk it springing back stronger than before. 

According to UNAIDS data, the number of new HIV infections declined by more than 26% globally since 2005. A massive scale-up of antiretroviral therapy has reduced the number of people dying from AIDS-related causes each year from 2.4 million in 2005 to 1.5 million in 2013. We are on the verge of eliminating the transmission of HIV from pregnant women to their babies, and we have succeed in reducing the cost of life-saving antiretroviral medication from US$ 10 000 per person per year in the mid-1990s to US$ 140 per year today. The fact that HIV treatment doubles as prevention (by reducing the risk of transmission by 96 percent) means that increasing the number of people accessing antiretroviral medicines both saves lives and reduces new HIV infections. Our goal is to ensure that by 2020 90 percent of people living with HIV know their status and 90 percent of people who know their status have access to treatment. 

Thanks to the dramatic progress of the past decade, driven significantly by American investment, we can now say with confidence that it is possible to end the AIDS epidemic by 2030. If we act with speed, focus  and determination we can avert 28 million new HIV infections and 21 million AIDS-related deaths by 2030.  This moment demands further generous support from all nations. 

Globally, domestic investments in the AIDS response are now higher than funding from international assistance. While some countries still rely heavily on external aid, progress on reducing dependence on external funders has been made in a number of countries. For example, Zimbabwe and Kenya earmark a portion of domestic tax revenues for an AIDS trust fund, and Benin, Congo, Madagascar, Mali, Mauritius, Niger, Rwanda and Uganda have initiated special taxes on mobile phone usage or airfares to help finance the response to HIV. South Africa now largely funds its own HIV programs, investing more than US $2 billion per year.

The bicameral, bipartisan, unanimous Congressional reauthorization of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) in 2013 demonstrated that ending the AIDS epidemic is an issue that can transcend politics. Such unified support sent a powerful message to the rest of the world and helped mobilize additional resources from both long-standing and new supporters.

As with every great potential success, there is the risk of stepping back at precisely the wrong moment. As Nelson Mandela said, “When the water starts boiling, it is foolish to turn off the heat.” If there was ever a moment to collectively recommit to ending the AIDS epidemic in our lifetimes, it is now. 

Sidibe is under-secretary general of the United Nations and executive director of the Joint United Nations Programme on HIV/AIDS.

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