Bill Clinton :
My first encounter with AIDS came in the 1980s, when I was governor of Arkansas. A close friend had contracted the virus, and I’ll never forget visiting him in the hospital. His face and body were covered in the black lesions that were the hallmark of Kaposi’s sarcoma and, without the benefit of antiretroviral therapy, he died not long after my visit.
It was hard to imagine then a time when we might be able to provide a normal lifespan to people living with HIV, limit its spread and actually envision an end to AIDS.
Over the past 15 years of the global fight against HIV, we’ve made a lot of progress and learned important lessons about the impact of AIDS on public health and development around the world.
If we’ve learned anything, it’s that when we neglect lethal infectious diseases, the problem will become bigger, more costly and more difficult to solve in the long run. We’ve seen this most recently with the Ebola crisis in West Africa. If we had responded to the AIDS crisis sooner and on a wider scale, the epidemic might have been managed with less loss of life. Instead, it became one of the most expensive and difficult undertakings in public health history.
‘AIDS is a global challenge, but it is also an inherently local one.’
The good news is that, since the global community found the will to act, remarkable progress has been made, illustrating a second lesson: when we come together across sectors, cultures and continents, there’s virtually no limit to what we can accomplish. Thanks to the combined efforts of governments of countries with large infection rates, national and institutional donors, nongovernmental organizations (NGOs) and private businesses, scientists and health workers, the global AIDS response has become one of the greatest examples of ambitious thinking and creative problem-solving the world has ever seen.
When we founded the Clinton Health Access Initiative (CHAI) in 2002, there were only about 200 000 people in low- and middle-income countries receiving treatment for HIV, mostly in Brazil and Thailand. For most of these countries, generic drugs cost between US$ 400 and US$ 500 per year?-?much less than we were paying in the United States of America, but still far too much in places where incomes could hover around US$ 1-2 per day.
We quickly realized that drug companies needed to move from a high-cost, low-volume pricing model to one that was high-volume, low-cost, and we set about raising money, improving delivery methods and negotiating lower price contracts between health ministries and drug suppliers. It’s hard to believe that, back then, it seemed nearly impossible that we could help nearly 15 million people gain access to HIV medications, not only for those under contracts CHAI negotiated, but for other purchasers as well. For example, between 2009 and 2012, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) increased its coverage from 1.7 million to 5.1 million people at no extra cost.
The global community believed that a life in Lilongwe or Lusaka was worth saving as much as a life in New York or San Francisco, and we got to work on it, creating institutions like UNAIDS, the Global Fund to Fight AIDS, 43 Tuberculosis and Malaria, PEPFAR, and UNITAID, which mobilized unprecedented resources, with remarkable contributions from NGO donors led by the Gates Foundation, and implementers like Doctors Without Borders, Partners in Health, CHAI and many others.
Today, we are well on our way to ending AIDS, but much more work remains.
Ending the AIDS epidemic is primarily a logistical challenge now, and until scientists discover a cure, the most effective tool we have is to provide treatment for all who need it?-?and to provide it as early as possible. The evidence is strong that early treatment goes a long way towards preventing new infections and helping people live long, productive lives. This means starting by ending mother-to-child transmission, an initiative that has shown great promise and early success. Treatment for both adults and children is far cheaper than it was even a few years ago?-?in fact, we are already spending more money on HIV every year than it would cost to treat every single individual who carries the virus?-?so over the next five years we should strive to achieve universal treatment. We can afford to be ambitious. Not to be will actually cost more, in lives and money.
“When we come together across sectors, cultures and continents, there’s virtually no limit to what we can accomplish.”
To achieve this goal, we need to help countries reach the millions of people within their borders who may not know they are infected by providing higher-quality, lower-cost diagnostics and helping to build efficient health systems that can deliver them where they are most needed. This will be particularly important – and particularly challenging – in big countries like Nigeria and the Democratic Republic of the Congo. It will also be important in countries with lower burdens, where HIV is ignored or where the epidemic persists among members of marginalized groups. It can be done. For example, in Mozambique, with the support of the national government and CHAI, laboratory technicians now set out across lakes in canoes visiting rural communities with point-of-care devices that can help increase rates of antiretroviral therapy initiation and better monitor patients’ viral loads across a lifetime of care.
Most important, we need to support developing countries in their efforts to manage and finance their own responses. AIDS is a global challenge, but it is also an inherently local one. Donors must give a high priority to helping ministries of health around the world put in place the qualified community health workers and effective health systems necessary to develop and sustain national treatment programmes. Good systems will also empower them to limit the impact of other problems, including a reappearance of Ebola, diarrhoea and, in Haiti, the persistence of cholera.
As we work to meet the new UNAIDS 90-90-90 targets, it’s worth remembering where we started and how far we’ve come. Going forward, we must use the lessons of the past to inform the efforts of the future. If we remember what is possible when we all work together, we will be able to overcome the challenge much sooner than many people think and enjoy a future where AIDS is a thing of the past.
(Bill Clinton, Founder of the Clinton Foundation and 42nd President of the United States of America)
