PARIS – At a Saturday session here UNAIDS leader Michel Sidibé remembered his early days at UNICEF in Swaziland, when the sweep of HIV in southern Africa, ignored and neglected, threatened the survival of entire nations.
“We were thinking that Botswana will not be on the map,” he said, “that Swaziland would disappear. It was only despair. Hope was not there.”
He spoke a couple of days after 2016 UNAIDS numbers released here showed midpoint progress toward goals set in 2014 for 2020 to end HIV as a global health threat by 2030. Speakers who joined Sidibe Saturday agreed the numbers showed those goals — for 90 percent of people with HIV to be aware of it, for 90 percent of them to be receiving antiretroviral treatment, and for treatment to be suppressing the virus in 90 percent of them — could be met.
In Botswana, Sidibe noted, they already have been. (And, on Monday, data from population surveys in Swaziland showed that country having cut numbers of new infections in half, and doubled the numbers of people living with HIV whose viruses are suppressed during the last six years.)
The UNAIDS report, analyzing data from 168 countries, showed 70 percent of people with HIV know their status, 77 percent of those diagnosed are on treatment, and 82 percent of those on treatment achieved viral suppression. But the UNAIDS numbers reflect country averages, and as U.S. Global AIDS Coordinator Ambassador Deborah Birx put it, PEPFAR measurements of success are “not as generous” as those of UNAIDS, not, she added, until the goals have been achieved across all geographic regions, age bands and subpopulations.
The numbers in any case came at a time when both global health leaders as well as health ministers here aired fears that complacency would stymie further progress. And even as the numbers show once unhoped for progress, they also show a notable breadth of unfinished work from low levels of care and treatment engagement for men almost everywhere, low levels of treatment coverage for children, and continuing high rates of new infections among adolescent girls.
“No level of funding can compensate for lack of political commitment,” remarked Marijke Wijnroks, the Interim Executive Director of the Global Fund to Fight AIDS, Tuberculosis & Malaria. In the “countries that made the least progress,” she added, “conflict and lack of political commitment were more important than lack of funding.”
Domestic funding is up to 57 percent for the HIV response from 50 percent a few years ago, she noted, and with more money to spend on health as a result of economic growth, she argued that countries should be open to the investment case that the HIV response creates a platform that can be used to respond to other health problems. But, she added, a gap of $7 billion needed to accomplish the goals cannot be filled by domestic spending increases.
This gap, in turn, comes at a time, that, as Amb. Birx later acknowledged, a new administration would like the U.S. global AIDS response “to do more with less.”
“No,” she added, “we are not going to just work in 12 to 13 countries but they will be the model while still continuing our work in 50 plus countries.”
That description, however is at odds with both Secretary of State Rex Tillerson’s testimony before Congress, and with the administration’s Major Savings and Reforms budget justification document which outlined plans to“continue to work towards epidemic control” in just 12 countries, and plans described by Tillerson before appropriators “to sustain the HIV AIDS treatments in 11 countries to continue to take those to conclusion. As patients roll off those rolls, new treatments can be available.”
In contrast Botswana Health Minister Dorcas Makgato described the determination and realism that allowed her country, with 18.5 percent HIV prevalence, to become one of only seven countries to achieve the 90-90-90 goals, and the only one in sub-Saharan Africa. She credited “bold political leadership, a declaration of HIV/AIDS as a national disaster, and approaching the HIV response as an investment” with this achievement and moving life expectancy in Botswana from the low fifties to 64 years.
Lesotho’s former health minister also shared information about “test and treat” efforts in Lesotho including the establishment of cross border clinics to engage men and women on their way to and from South Africa for employment and picked up on the theme of investment. “Fighting HIV is a matter of survival. We don’t have diamonds, we have human capital and we must invest in it,” he said.
The 90-90-90 goals gave both governments a clear target, both said, fueling and focusing their efforts.
“People don’t pay for coverage,”Sidibé said, “they pay for impact.”