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Celebrating World AIDS Day: Getting to Zero

This blog entry was originally posted on the CapacityPlus blog.

Every December 1st, I pull out a small red ribbon and attach it to my sweater to commemorate World AIDS Day. To me, this is a very important day to raise awareness about the HIV/AIDS epidemic and reflect on both where we have made achievements in battling the epidemic and where we really need to persevere to do better. This year through 2015, World AIDS Day has a special theme: "Getting to zero: Zero new HIV infections. Zero discrimination. Zero AIDS-related deaths."

People with HIV are living longer

Though gains have been made in reducing the number of new HIV infections, there is still a significant portion of our global population living with AIDS. According to UNAIDS, an estimated 34 million people were living with HIV in 2010, an increase of 17% from 2001. These numbers tell several stories. First, the vast expansion of ARV treatment and the reduced cost in treating AIDS have allowed more AIDS patients treatment than ever before. In addition, people with AIDS are living longer than ever before. AIDS-related deaths fell to 1.8 million in 2010, down from 2.2 million in the mid-2000s, and since ARVs have become more widely available, several million more deaths have been averted. However, there are still a significant number of new HIV infections each year. There were 2.7 million new HIV infections in 2010, of which 70% were in sub-Saharan Africa. Though the number of new infections is on the decline from their peak in 1997, the high numbers of new infections make for further challenges in curbing the spread of the disease.

Overcoming vertical challenges

For many years the global health community has called for the elimination of silos or parallel systems for services in favor of a more integrated service delivery approach. There has been a significant amount of success in integrating HIV prevention and treatment with other service delivery components such as tuberculosis. Likewise, integration has been prioritized by donors and implementers. The US Government’s Global Health Initiative (GHI) has identified integration as one of its key principles, calling for increased impact through strategic coordination and integration. Specifically addressing the AIDS epidemic, UNAIDS has listed strengthening HIV integration as one of its 2011 political declaration commitments.

While we are making progress integrating services in some areas, we specifically need more integration of HIV/AIDS and family planning. Family planning counseling and treatment offers an ideal time to educate clients on HIV prevention and provide HIV testing and subsequent HIV counseling. In fact, it is more than providing a package of services all at one time; family planning has an important role to play in curbing the spread of HIV by providing a platform to promote barrier contraceptive methods not only to avoid unintended pregnancy but also to reduce the spread of HIV and other sexually transmitted infections. 

This week, all eyes and ears are attuned to the tweets, RSS feeds, and other media messages from the 2011 International Conference on Family Planning in Dakar, Senegal, where thousands of public health professionals have come together to share research, best practices, and progress on national strategies to deliver family planning services. Undoubtedly, family planning and HIV/AIDS integration will be featured prominently.

Success depends on a strong health workforce

Providing HIV/AIDS prevention and treatment services takes a qualified health workforce, yet the global health worker crisis is hindering success in combatting the AIDS epidemic. The World Health Organization identified 57 countries as having a critical shortage of health workers; ten were original focus countries for the US President’s Emergency Plan for AIDS Relief, and seven are GHI-Plus countries. In these countries, specific health workforce strengthening efforts are needed to increase the number of health workers, address maldistribution of the workforce in rural areas, make certain health workers are adequately trained in relevant competencies such as HIV prevention, treatment, and care, and ensure robust health systems are in place to support health workers.

No one can deny the impact of the AIDS epidemic on the health workforce. AIDS deaths among health workers and AIDS-related absenteeism have decreased the number of health workers, subsequently increasing the workload of those remaining. If we have any hope of meeting Millennium Development Goal 6, which is focused on combating HIV/AIDS, malaria, and other diseases, we need to accelerate progress for sustainable human resources for health interventions so that vulnerable populations have access to qualified health workers who are supported to provide HIV prevention, treatment, and care services.

Optimism for the future generation

Despite the long road ahead we have made significant gains. For example, between 1997 and 2010, annual infections fell by 21%, And in sub-Saharan Africa, ARV coverage rose 20% between 2009 and 2010.  

In November, US Secretary of State Hilary Clinton called on the world to create an “AIDS-free generation” where no children would be born with the virus, those children would grow up with a lower risk of becoming infected and should they acquire HIV, they would have access to treatment that prevents them from developing AIDS and spreading the virus. Secretary Clinton says this AIDS-free generation is possible if we continue investing in research and development and putting into practice approaches with scientific evidence supporting the reduction of the spread of HIV/AIDS. 

It is encouraging to see such a bold statement make headlines. This year, as I commemorate World AIDS Day, I will do so with optimism like that of Secretary Clinton.