As conference presenters prepare to unveil successes, advances — and it is hoped, plans — to turn the tide of the epidemic together, events Saturday offered opportunities to reflect on lessons learned and paths paved by work in the last decade.
At the Pan American Health Organization, representatives of El Salvador, Brazil, Jamaica, Peru and Uruguay talked about “Treatment 2.0” — more accessible, affordable, community-based HIV care and treatment as prevention of transmission, and its similarity to the the basic principles of primary care. Citing successes in addressing tuberculosis, mother-to-child HIV transmission, pediatric HIV, they pointed to the effectiveness of integrated health systems, developed in country, in response to geographic, cultural and infrastructure conditions. The good news is that the lessons learned from learning to treat HIV as a chronic disease will apply to and improve treatment of other chronic diseases, they agreed.
Then, over at the Center for Strategic and International Studies, panelists who have seen the President’s Emergency Plan For AIDS Relief through, from its start as a late, but unprecedentedly ambitious response to a two-decade global health crisis, to its chance now to lead the way to the end of the epidemic, took the opportunity of the release of an all-PEPFAR issues of the Journal of AIDS to reflect on the program’s successes. Pointing to the realized and potential “strategic” advantages the plan had brought — good will, national security, the economic advantages of a healthy developing world — along with its moral underpinnings, panelists that included first Global AIDS Coordinator Amb. Mark Dybul, present coordinator Amb. Eric Goosby, National Institute of Allergy and Infectious Diseases Director Anthony Fauci, and CSIS Global Health Policy Center Director J. Stephen Morrison traced a challenging and rewarding path.
The content of both events supported optimistic projections. Both reflected on obstacles — resources, funding, politics, and fatigue. But as most of us, and those who work for governments perhaps all the more so, enjoy celebrating our victories more than pondering our mistakes, both events were short on the opportunities some of the lessons learned, or yet to be learned, presented. The roles of gender inequities got light play in the PAHO session, the effects of intolerance for sexual minorities went all but unmentioned. And if the nearly all-male panel (one woman among 12 speakers) discussed the lessons learned from efforts that excluded family planning, commercial sex workers, and that left a mostly female corps of community-caregivers unpaid, it was fleeting enough to miss. The realities of the road to “country ownership” also went largely unmentioned, until in the final panel, Dr. David Serwadda of Uganda said, “Let’s be honest, PEPFAR in the first year was not country owned.”
Acknowledging wrong turns might improve the mapping of the route ahead. The chance to bask in the light at the end of the tunnel was earned, though, and both events raised hopes for a bright week ahead.