01/29/2013 08:05 EST | Updated 03/31/2013 05:12 EDT

Could the Next Generation Be AIDS-Free?

Recently, there has been much momentum around ending AIDS. UNAIDS, the United Nations agency in charge of helping countries to respond to HIV, published its aptly titled report, "Results", which detailed advancements in the global response to AIDS.

Notably, the report describes up to a 50 per cent reduction in new HIV infections, 25 per cent increased coverage of HIV anti-retroviral therapy and fewer AIDS-related deaths. This is good news and it gets better when you consider that these changes occurred in countries that have high disease burdens.

However, if we are to look back at the history of the epidemic and what it has taken us to get to where we are now, we will see that this has been a painful journey. For many, where we are today could have been reached years before; it has taken far too many deaths for our political leaders to wake up and start acting.

By their failure to act, the AIDS epidemic has shown them at their worst. The last 30 years for HIV advocates has been agonizing; often acting as a lone voice, many of us have watched friends, partners and family die before any meaningful investment was made to respond to the epidemic. That we should even be talking about ending AIDS is a testament to the hard work and dedication of those who faced great adversity to get us to where we are now.

Yet in the face of these advancements, the outlook isn't all rosy. The same UNAIDS report also detailed that in 2011, 2.5 million people became infected with HIV. Of this amount, 97 per cent are from low and middle income countries; 47 per cent are women and 39 per cent are young people between 15-24 years old.

So what's the real picture?

If we are to be frank, the reality is paradoxical; while we have reasons to be optimistic, this depends on certain factors holding constant -- a theme that is also implicit in the recent President's Emergency Plan for AIDS Relief (PEPFAR) "Blueprint for Ending AIDS" which attempts to chart a course for ending AIDS. Recent scientific developments have significantly altered our outlook on the future of the AIDS pandemic.

Particularly, findings from a recent study conducted by HIV Prevention Trails Network (HPTN) on antiretroviral therapy show that ARV treatment can reduce the likelihood of transmission of HIV to an uninfected partner by a significant 96 per cent among heterosexual couples. This is hopeful sign for many of us who work on treatment access and HIV prevention.

If accompanied by an increase in the availability of prevention tools including family planning services for women and girls, we just might have a clear path to radically reducing the transmission of HIV and changing its course for the next generation. As well, if we are to keep the momentum going, there must be increased investments by the international donor community to HIV and AIDS financing.

Moreover, national governments must also play their part by increasing domestic HIV spending as well as starting processes of removing barriers to HIV testing and treatment. There must also be vigorous legal reform to eliminate discriminatory practices which contribute to high infection rates and HIV vulnerability.

That we should have laws criminalizing same-sex behavior, expression and HIV non-disclosure counters our efforts to reduce HIV transmission. This must be done analogously by addressing stigma and discrimination which act as ubiquitous factors determining the outcome of all our efforts.

Across the world, the hardest hit communities are those that are most stigmatized, for example, across the Caribbean, the Middle East, Eastern Europe and parts of Africa, the fastest growing epidemics are among gay and bisexual men, transgender persons, sex workers and people who use drugs. This has been an established fact for the last three decades, yet these communities continue to have high infection rates due the challenges they face in their countries.

Similarly, social determinants such as race and other socio-economic factors have influenced high rates of infection among these groups across North America and Europe. While we are finally at a place where we have the science to eliminate the spread of HIV, we are still not yet at a tipping point due to the retention of discriminatory laws and practices that have prevented us from reaching those who are at the heart of the epidemic.

Achieving AIDS-Free Generation

The theme for World AIDS Day over the next three years will be "Getting to Zero: Zero new infections, Zero discrimination and Zero AIDS related deaths." This message is powerful, however if we are serious about making this a reality, then we need to start purposively tackling the challenges that have hindered our progress so far.

The end of this theme in 2015 will also coincide with the deadline to achieve the Millennium Development Goals and the beginning of what is expected to be a start to reverse the spread of HIV. If we are to make this happen, we have no time to lose. The future of our response requires us to address old problems such as poverty and gender inequality and new ones like unfair trade rules and practices which block access to lifesaving anti-retroviral drugs to those that need them most.

Without addressing these problems, we risk reversing the gains we have made over the last three decades. No matter what the challenges of our time are, we cannot go back on our promise to achieve the highest attainable living standards for all people which includes working for universal health coverage and maintaining the highest attainable human rights standards.

We are in a time that requires strong leadership and as we work towards the deadline for a new development framework over the next three years our cooperation and our willingness to achieve an AIDS-free generation will be tested. Given what we know, there is a roadmap emerging that will lead us to reversing the spread of HIV and if we stay the course we will also address other global development challenges.

This is a time when we cannot give in to fear, bad practices and prejudice. The time to act is now; we have come too far with a turning point too close to not get it right. We simply cannot allow a failure to happen; we have much at stake and future generations are depending on us.

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