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Fighting AIDS domestically and globally means pushing more evidence-based services
Last week in his state of the union address the president, noting dramatic scientific progress in addressing HIV/AIDS, pledged that "Together, we will defeat AIDS in America. And beyond." The next day the Department of Health and Human Services released a fact sheet on the plan to end the AIDS epidemic in America. A corresponding article in JAMA provides additional details.
We need the plan to end the global AIDS epidemic as well, an international tragedy in which 15 million people living with HIV are still not accessing lifesaving treatment and 1.8 million people are newly infected each year. And the fact sheet for that global effort would look strikingly similar to the domestic plan.
Success in both domestic and global AIDS epidemics depends on scaling up evidence-based services, focusing on locations and populations where HIV infection is high, tackling HIV-related stigma, boosting the healthcare workforce and helping people stay in care.
Here in America and globally we have to address the social context in which people are vulnerable and understand that marginalization and stigma are among our greatest challenges. The JAMA article calls for creating "environments in which all people, no matter their cultural background or risk profile, feel welcome for prevention and treatment services," and for delivering evidence-based harm reduction services.
The potential to end the AIDS epidemic at home and abroad hinges on a robust research effort: for a cure, a vaccine, better treatment and prevention and for understanding how to deliver services most effectively. It will require insisting on and measuring tangible outcomes and adjusting strategy as lessons are learned.
We've seen these principles in action in American cities that have succeeded in driving down HIV incidence and mortality: communities have used the latest research to provide universal access to treatment, targeted prevention that includes use of antivirals to prevent infection, harm reduction and concerted efforts to help all people feel treated with dignity as they seek care.
There is a roadmap for success against HIV. But it must be funded adequately. In his speech, the president said he would send Congress a budget with, "the needed commitment to eliminate the HIV epidemic in the United States within 10 years."
Such a commitment is needed to end the global epidemic as well. That investment would save tens of millions of lives, foster economic development, buttress America's health security and our advance our reputation in the world. America needs to take the lead, but that leadership doesn't mean we should foot the whole bill. We should challenge other donors to join us in a stepped-up effort as we increase our own investment. We should applaud notable increases in investments by heavily affected countries and encourage them to do more.
The JAMA paper notes the consistently impressive results from America's central global AIDS programs: the President's Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund). Increasing our investment in these successful programs is the starting place for implementing a plan to end the global epidemic.
This year presents a special opportunity. The Global Fund holds its 6th Replenishment in October. By law, the U.S. cannot provide more than 33 percent of all Global Fund resources, so our pledge leverages donations from other donors who don't want to leave U.S. funding on the table.
One of the beauties of the Global Fund is that it propels others to step up. A three-year U.S. replenishment pledge of $4.68 billion (or $1.56 billion a year) will save millions of lives and drive others to increase their own contributions and achieve the Global Fund's overall $14 billion replenishment goal.
America's AIDS epidemic is not separate from the global epidemic, but part of it. Both feed on inequality and lack of access to services. And both can, and must, be ended.
Chris Collins is the president at Friends of the Global Fight Against AIDS, Tuberculosis and Malaria.