April 15, 2011
Brown Journal of World Affairs: Let's talk about how far the world has come in combating AIDS in the decade that has passed since the Declaration of Commitment. How do you see the UNAIDS Strategy, "Getting to Zero," helping to advance this effort?
Michel Sidibé: I want to begin by saluting the Brown Journal of World Affairs for publishing a series of papers on the politics of AIDS. As the Executive Director of UNAIDS, I have consistently called for a more political approach to the AIDS response. "Know your epidemic; know your response; act on its politics" is my mantra.
Let me begin to answer your question by expressing some surprise that the world of political science and international relations has not taken the interest I would have expected in the AIDS response. I say this because of the remarkable success of the AIDS response since the Declaration of Commitment in 2001. We have witnessed a dramatic decline in the number of people getting infected every year-20 percent since 2001-while the biggest epidemics in sub-Saharan Africa have either stabilized or are declining. We have also seen a major increase in funding from $300 million in 1996, when UNAIDS was launched, to $16 billion in 2009. This has enabled us to move from a reality where virtually no one in low- and middle-income countries had access to treatment to over six million people living with HIV on treatment today.
When you think about it, these achievements represent an unprecedented triumph for global health and a remarkable reflection of the politics of global solidarity and community activism. As we all know, HIV has been terribly stigmatized. People living with HIV, particularly women, and people most vulnerable to HIV, face widespread discrimination. Yet, with vision, tenacity and creativity, it is precisely these courageous people who succeeded against all odds in making real the principle of "Health for All" through the movement around universal access to HIV prevention, treatment, care and support. It was this political dynamism that accounted for AIDS being the first disease ever discussed by the Security Council. It was the same political activism that challenged global trading rules and brought about the widespread availability of generic antiretroviral medication. And it was community organizing that shifted long-standing social norms-like the acceptance of male circumcision which protects against infection in cultures that didn't traditionally circumcise. These are remarkable achievements that have their roots in politics-not just medicine.
But AIDS is far from over. Two people are newly infected for every person that manages to access treatment, while over 10 million people are eligible for treatment but lack access. We desperately need to achieve an AIDS transition that sees more people getting treatment than are newly infected. Resources for the AIDS response have flatlined, and while we continue to improve the efficiency of delivering services and generate economies of scale to save money, the reality is that many patients will need to graduate to more expensive therapies. People living with HIV still face discrimination: for example, around 50 countries still have HIV-related restrictions on entry, stay and residence. Moreover, some 120 countries have laws in place that make it difficult, if not impossible, for some people-like men who have sex with men, sex workers, and people who use drugs-to access HIV-related services, increasing their vulnerability to infection. It is this unfinished agenda that led us to adopt a long-term vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths.
The UNAIDS Strategy, "Getting to Zero," recognizes that the global response stands at a pivotal juncture, where the gains of the past are at risk and current approaches are reaching their limits. We have identified three mutually reinforcing Strategic Directions for a renewed response: revolutionizing HIV prevention; catalyzing the next generation of treatment, care and support; and advancing human rights and gender equality. …