HIV/AIDS: Experts call for radical change in strategy:
HIV/AIDS prevention is in crisis, particularly vulnerable populations continue to remain out of reach of the health system, and the global momentum, which has mobilized unprecedented resources and saved millions of lives, is declining. The HIV/AIDS only model, which had prevailed since the beginning of the pandemic and led to the creation of specific programs and structures, no longer responds adequately. It must leave room for an approach where the fight against the human immunodeficiency virus would be integrated into broader health programs also targeting the diseases that are linked to it.
This is the conclusion reached by 47 professionals involved in the response to this pandemic that has already killed more than 35 million people. After two years working on a commission assembled by the International AIDS Society (IAS), organizer of international sessions on HIV/AIDS, and the medical weekly The Lancet, they invitation this change of paradigm.
The fruit of their work appears in a special issue of the magazine published Friday, July 20. Among the participants of the paper are current IAS President Linda-Gail Bekker and her predecessor Chris Beyrer as well as former Executive Director of UNAIDS Peter Piot and two former Executive Directors of the Global Fund AIDS, Tuberculosis and Malaria, Michel Kazatchkine and Mark Dybul, and former President of Aides, Bruno Spire.
The tone is clearly different from that of international organisations such as UNAIDS or the Global Fund, which emphasize the unquestionable progress made. The commission questions the dominant discourse in recent years centered on the prospect of ending HIV/AIDS.
According to the commission, the hype on this aim set in 2030 by the United Nations has “fueled a dangerous complacency and may have hastened the weakening of global determination to fight HIV.” Believing that “existing HIV/AIDS tools and strategies are insufficient and that dramatic progress can be achieved by maximizing current prevention and treatment strategies, the HIV pandemic is likely to remain a major global challenge in the near future” , Says the Lancet document .
Peter Piot sees a reflection of this complacency in flattening the curve of financial resources, international and national, devoted to fight against HIV. “We are very concerned at the prospect of seeing the world proclaim a victory well before our fight against AIDS is completed. It would be catastrophic, because we have seen epidemics rebound, for example malaria, which was planned elimination, “he warns.
Going further than the report issued Wednesday, July 18 by UNAIDS , which advocates combining a supply of prevention and care for HIV and TB, the commission advocates integrated services that respond to HIV and other diseases that share transmission routes, affect the same risk groups and often coexist in patients. Such an offer would include sexual and reproductive health, tuberculosis, viral hepatitis, drug addiction, and mental disorders, Chris Beyrer summarizes.
It could also be spread to chronic diseases such as diabetes and high blood pressure (hypertension). The commission’s modeling illustrates the positive cost-effectiveness of such an approach to HIV: for example, the integrated offer combining HIV, diabetes and hypertension testing over ten years would prevent 69,000 infections. In South Africa and 216,000 in Kenya. “There has never been a blood pressure campaign in my country,” says Nduku Kilonzo of Kenya’s National AIDS Control Council, who is a signatory to the commission’s document. The debate has begun.