It was exciting to see that political commitment to end AIDS was strong during ‘GA Week’, the opening of the 72nd Session of the United Nations General Assembly (UNGA) in New York. The high-level discussions were inspiring and have renewed our hope that we are close to seeing the fruition of decades of work. There is no doubt about the unprecedented progress made in reversing the tide of the HIV epidemic. More than half of people living with HIV access life-saving treatment, and AIDS-related mortality has decreased by 50 per cent in the last decade.
At the Fast-Track to End AIDS event organized by UNAIDS, African presidents and partners highlighted the success of the global HIV response. Among the speakers in attendance were the Presidents of Botswana, Guinea, Malawi, Seychelles, Uganda and Zambia, the King of Swaziland and the First Ladies of Côte d’Ivoire, Namibia and Panama. During this event, PEPFAR announced that population-based studies on HIV incidence show that new HIV infection rates have declined in five sub-Saharan African countries (Lesotho, Malawi, Swaziland, Zambia and Zimbabwe). Yet, as President Museveni of Uganda reminded us, we cannot grow complacent or weary as we approach the finish line.
In fact, the finish line may be a mirage. In Africa, 60 per cent of the population is under 24 years of age, and adolescents and young people, especially girls, have the fastest growing rates of HIV infection. If we do not act quickly, the gains achieved may even be reversed in the next decade. The Organization of African First Ladies Against HIV/AIDS (OAFLA) called on global partners to view this “youth bulge” as an opportunity to provide more responsive and youth-friendly health services. This means providing an array of health and social services that address the multiple vulnerabilities of adolescents and young people, especially girls, and empower them to make informed decisions about their lives and health. This includes: improving access to HIV and sexual and reproductive health services, keeping children and adolescents in school to empower them with knowledge and life skills, providing economic opportunities and ensuring young voices are heard.
- The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), a major donor for the HIV response, released its new Strategy for Accelerating HIV/AIDS Epidemic Control (2017-2020), which focuses on 13 high-burden countries. The strategy outlines key steps which centre on expanding HIV prevention for young women and men and improving the use of epidemiological and cost data, among other priorities.
- Unitaid, at an event hosted with the President of Chile and 18 other female leaders, issued a statement to place reproductive, maternal, newborn, child and adolescent health front and centre of efforts to accelerate the global response against HIV/AIDS, tuberculosis and malaria. In a joint statement, President Michelle Bachelet and Celso Amorim, Chair of Unitaid’s Executive Board, issued a call to action to increase investment in innovative solutions to prevent and treat the three diseases in women and children. In line with UNICEF’s mandate, the joint statement also emphasized reducing inequities, especially for the most vulnerable populations.
- The Global Fund for AIDS, Tuberculosis and Malaria held a reception to invigorate the response towards achieving SDG target 3.3, which includes ending these three diseases. Remarks by UNAIDS, the Stop TB Partnership, the Roll Back Malaria Partnership and the Global Fund emphasized that emerging challenges such as resistance to ARVs, antibiotics and insecticides underscore the need to leverage innovations. Scaling up integrated service delivery and sustained investment are needed to prevent setbacks and make the vision of ending AIDS, TB and malaria a reality.
- At an interfaith breakfast, the World Council of Churches Ecumenical Advocacy Alliance, in collaboration with UNAIDS, PEPFAR and the United Nations Interagency Task Force on Religion and Development, discussed ways to join forces to address the HIV treatment gap in children, which is due in large part to low testing rates. Faith-based organizations provide a significant proportion of HIV services in many low- and middle-income countries. Partners issued a call to action to coordinate the faith-based response to accelerating access to HIV prevention, testing and treatment for children and adolescents by 2020.
- UNAIDS and the Center for Sustainable Development at the Earth Institute hosted an event at Columbia University to discuss how to accelerate momentum towards the implementing the 2 Million Community Health Workers Initiative (2MCHWI), endorsed by African Heads of State earlier this year. With growing demand and constraints on health systems on the continent, community health workers (CHWs) have become the backbone of service delivery, bringing basic care closer to mothers and children. Countries such as Ethiopia, Ghana and Malawi have shown what can be achieved with a professionalized CHW cadre. Although it is estimated that a robust CHW cadre will cost an additional $7 per person per year, the benefits on health outcomes for women and children are worth the added cost.
- A call to action for adolescent girls could not have come at a better time. We are in the midst of “prevention revolution,” as Chris Breyer of John Hopkins University (JHU) said at the Bridging the gaps in HIV prevention through technology and innovation meeting, sponsored by JHU. Various trials have demonstrated the effectiveness of treatment as prevention and pre-exposure prophylaxis (PrEP) as a tool for preventing HIV acquisition in at-risk populations. In many high-prevalence settings, adolescent girls are at high risk of becoming infected. Professor Kamala Alexander of JHU underscored that addressing gender norms, stigma and discrimination and intimate partner violence is critical to reducing HIV risk among young and transgender women. This session also highlighted the new technologies/products (effective drugs, long-lasting injectables, implants) and platforms (mobile applications) that can make prevention services more accessible and acceptable.
- The newest science on HIV prevention was presented at a New York Academy of Sciences event sponsored by the Bill & Melinda Gates Foundation and the Microbiology and Infectious Diseases Discussion Group. Researchers presented several drug technologies in development that hold the promise of HIV protection for up to a year. Recent results show that removable implants with cabotegravir-based regimens performed best, and self-assembled injectable gels with ARVs were found to be stable and do not degrade as quickly as in other formulations. Research teams are also developing broadly neutralizing antibodies (bNabs) to prevent HIV. Based on trials, there is a “chorus of opinion” that bNabs in combination are more effective than a single antibody. The session focused on bNabs in the context of HIV prevention in adolescent and adult populations, but the presenters also cited their potential use in post-exposure prophylaxis, treatment and curative strategies.
- Making the most effective ARV regimens more affordable will also go a long way to enrolling more people on treatment and therefore contribute to prevention efforts. The Governments of South African and Kenya, along with UNAIDS and several donors, announced that a pricing agreement has been reached for the generic, dolutegravir (DTG)-based fixed-dose regimen. As a result, this regimen will be available to low- and middle-income countries at around US$75 per person, per year. The World Health Organization (WHO) recommends DTG as an alternative first-line HIV regimen. It is hoped that making DTG-based regimens more widely available will enable countries to treat more people living with HIV because the drugs are better tolerated. Although this is welcome news, developing similarly effective and tolerable regimens for children under 12 years of age must remain a priority.
These breakthroughs are truly encouraging. Yet, we must remember that HIV prevention and treatment are just as relevant in low-prevalence contexts where HIV infection rates are extremely high in key populations. We now have a broader combination of tools available now and on the horizon to scale up HIV prevention and treatment in ways that can make them safer and more convenient for all children and adolescents, including the most vulnerable populations and those at the highest risk.