July 2014 theglobalfund; To end HIV and AIDS as an epidemic, we have to move past the tyranny of averages and develop more focused approaches to HIV prevention and treatment.
It is in the fringes of society, such as among the sex workers of East Africa, men who have sex with men of the Caribbean, transgender people of Asia, people who inject drugs of Eastern Europe, young women and adolescent girls of Southern Africa that the disease continues rage, even as the rest of the world makes remarkable progress against it. To take advantage of the global gains against the epidemic, we must learn to isolate diverse hotspots, across the world to deliver more nuanced interventions.
While not dismissing larger-scale interventions, we are at a time in the history of the disease when sub-population and sub-national interventions should be put front and center in HIV programming. This especially calls for refined, hyper-local efforts that are informed by specific epidemiological intelligence of each locality.
Regional leaders, better still, local leaders, across the world have a tremendous opportunity to galvanize their populations to achieve victory against the pandemic. This is why the announcement by New York Governor Andrew Cuomo of a plan to end AIDS in New York State by 2020 is as energizing as it is encouraging.
Governor Cuomo’s administration plan, called “bend the curve,” includes: Identifying people with HIV who are still undiagnosed; getting HIV-positive people on antiretroviral therapy; and providing access to Pre-Exposure Prophylaxis to people at high risk. With a pointed attention to the people and the areas in the State disproportionately affected by the disease, local health officials can help New York achieve the 2020 targets. It is by galvanizing such local action against HIV that leaders all over the world can lead their people in being the generation that will achieve victory over this global pandemic.
Additionally, New York said that it expects to make a significant investment in the response to HIV with the aim of achieving a dramatic reduction in cost to the government through lower medical expenditures from success in disease prevention. This is true across the world. Investments in health today will translate to future savings and more wealth in the days to come.
To achieve lasting impact, the world is in need of leaders who will accelerate action and investments in health, especially against the world’s deadliest infectious diseases – HIV, tuberculosis and malaria. That means involving multiple stakeholders: from governments to private sector and civil society to create a social movement that will leave no one behind on the road to turning the pandemics into low-level endemics.
As in New York, it will help to define epidemiological locations that we want to reach to most effectively end the epidemic. By that I mean defined sub-national and sub-population levels, with a clear focus on populations most affected by the diseases. Zeroing in on specific areas and groups will help us avoid the one-size-fits-all strategies of the past. It will mean developing approaches that are guided by what will work in each context and informed by the lived experiences of those communities most impacted
More than a decade ago, you could spend money in any corner of the world and on any population and have a big impact. That is because people were dying everywhere and because interventions would lead to reductions in infections in many places. We have made great progress, but now we need to be smarter, more focused, much more nuanced.
If we do that, if we all come together to invest more in the right things and in smarter ways; if we take advantage of this historic moment, there is no doubt in my mind that we can bend the curve of this disease and end the epidemic altogether whether in New York or Bangkok, London or Lilongwe, Kingston or Kinshasa.