Academic journal article Bulletin of the World Health Organization

Redesigning the AIDS Response for Long-Term impact/Repenser la Riposte Au Sida Pour Un Impact a Long Terme

Academic journal article Bulletin of the World Health Organization

Redesigning the AIDS Response for Long-Term impact/Repenser la Riposte Au Sida Pour Un Impact a Long Terme

Article excerpt

Why aids2031?

Despite signs of progress, the world is far from beating the acquired immunodeficiency syndrome (AIDS). (1) In 2009 alone there were an estimated 2.6 million new human immunodeficiency virus (HIV) infections and 1.8 million deaths globally. (2) In 2009, 69% of the world's new HIV infections and 72% of the deaths were in sub-Saharan Africa, where average life expectancy in several countries has decreased by 20 years or more since 1990. (2) In these hyperendemic countries in sub-Saharan Africa, AIDS has had a significant adverse effect on maternal mortality rates (3) and is still the first cause of death overall.

Recognizing the need for a shift in the AIDS response from "crisis management to sustained strategic response" (4) the Joint United Nations Programme on HIV/AIDS (UNMDS) established an independent forum called aids2031, engaging scientists, policy-makers, programme managers and activists to take a long-term view on the direction of the epidemic and to consider what is needed to achieve better outcomes by 2031, the year that will mark 50 years since AIDS was first recognized. (5) The recent global financial crisis has also added urgency as resources for competing global problems become tighter.

Between 2007 and 2010, the aids2031 consortium convened working groups that focused on nine areas: social drivers of the epidemic, epidemiological and economic modelling, science and technology, the programmatic response, communications, leadership, financing, hyperendemic countries in sub-Saharan Africa, and countries in rapid economic transition in Asia. The working group participants, selected from a variety of disciplines and geographical areas, along with a group of young leaders, together engaged more than 500 people around the world to bring new ideas to address a pandemic that is still growing despite great investment and efforts to control it. The consortium's mandate was to ask what needs to be done better or differently now to radically reduce the number of new HIV infections and AIDS deaths by 2031.

The working groups consultations have resulted in international forums and debates, more than 30 working papers, reports (6,7) and a book(7) capturing key findings and recommendations. The aids2031 analyses assume a changing global context with many uncertainties--in politics, the environment, economics, technology and overall health and development. By 2031, changes will likely include a further shift in the global geopolitical and economic centre to Asia, especially China and India; unpredicted social changes; important advances in information technologies; (8) different models of development aid and global health funding; climate change; (9) and an already emerging dramatic shift in the global disease burden to higher rates of chronic diseases, (10) alongside persisting old and possibly new infectious diseases. By 2030, the world's population is expected to reach 8.3 billion people. (11)

Several recent events have changed the AIDS landscape. On the research side, there have been positive breakthroughs in demonstrating the effectiveness of treatment as prevention (12) as well as for oral and topical pre-exposure prophylaxis. (13-15) On the political side, the June 2011 United Nations' Security Council Resolution on HIV/AIDS (16) and General Assembly Political Declaration on HIV/AIDS (17) reflect renewed political engagement and a changed strategy that focuses on highest risk populations, even though this may be more politically sensitive. (18)

The first three decades

The AIDS epidemic has evolved in a unique way. (19) First, there were rapid scientific breakthroughs. However, early over-optimistic statements encouraged the public to believe that medical science could develop a vaccine in a much shorter time-frame than has been feasible. The difficulty of changing sexual and drug-using behaviours was also greatly underestimated.

Second, the AIDS epidemic engaged an exceptional coalition of scientists, activists and policy-makers that helped mobilize funds. …

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