World AIDS Day: A moment to align realities, priorities, actions and goals

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The release of the UNAIDS Fast-Track report a couple of weeks ago set a hopeful tone that reverberates this World AIDS Day in proclamations and promises from around the globe. It said that if in the next 15 years 95 percent of people living with HIV had been diagnosed, 95 percent of those people were receiving antiretroviral treatment, and if treatment of 95 percent of those people effectively controlled their viruses, the AIDS epidemic as we know it would be over by 2030. The optimism spurred by the possibility those goals offered of ending the AIDS epidemic was amplified in a statement from the Global Fund to Fight AIDS, Tuberculosis and Malaria supporting the UNAIDS “plan,” by mayors and municipal representatives from around the world who gathered in Paris and pledged to make those goals realities in their cities, and in U.S. President Barack Obama’s reference to “the day we know is possible — when no child has to know the pain of HIV/AIDS and no life is limited by the disease.”

cdcvitalsignsBut while the projections in the UNAIDS report establish meaningful goals, findings released in the week running up to this day make clear that reaching those goals will require unprecedented commitment, planning and resources. Data from seven African countries, presented in the Nov. 28 Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report show that while more wide-spread access to antiretroviral treatment has led HIV-related deaths to drop by nearly a third, estimated HIV-related deaths among teenagers have increased by about 50 percent. The third in a series of reports from ONE, Tracking Global Commitments on AIDS notes that while 2013 marked the first time the number of people were enrolled in antiretroviral treatment programs exceeded the number of people who became infected with HIV that year, efforts to confront HIV have continued to focus on those easiest to reach, funding for those efforts continues to be limited and challenged, and health system weaknesses continue to threaten progress. And the challenges cited in the ONE report are not unique to resource-poor countries, another report from the CDC shows. In contrast to the goals the UNAIDS Fast-Track report call for, numbers released last week in a Vital Signs report show just 30 percent of the 1.2 million people living with HIV in the United States have the virus under control. As an Op-ed piece on The Hill’s Congress Blog notes, of the 2 million people who were infected with HIV last year, an estimated 50,000 live in the U.S., which remains one of 30 countries accounting for nearly 90 percent of HIV incidence worldwide. Dr. Adaora Adimora, the author of that piece, an HIV clinician and researcher, as well as chair of the HIV Medicine Association, also notes that in the U.S. too, political priorities have left “the poorest among us without access to health insurance coverage.”

All of this highlights that while the Global Fund threw support behind what its statement called UNAIDS “plan to end AIDS by 2030,”  the Fast-Track numbers are not a plan, but goals, that the mayors who gathered in Paris to support the goals will in turn need support themselves, and that reaching the day that President Obama said, “we know is possible” will require a plan as well as political will and resources.

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