This year marks 30 years since the creation of the International AIDS Society (IAS), an important moment of reflection for our organization. We were founded in 1988 by a group of scientist-activists desperate to share information to stop the pandemic spreading around them.
When the IAS was first created, there was no treatment for HIV and no prevention of mother-to-child transmission.
There was pervasive stigma and discrimination, limited understanding of HIV transmission and disease progression, a lack of awareness of the degree to which HIV was predominantly spreading in sub-Saharan Africa, and by and large only condoms for prevention. To overcome massive challenges, those scientist-activists had to address the politics that stood in the way of achieving an effective response to the epidemic.
Since that time, astonishing scientific advances helped transform the fight against HIV, shifting the discourse on HIV from an urgent, activism-led discussion to a more technocratic, biomedical one – obscuring the political dimensions along the way. But in this moment of truth – when talk of “ending AIDS” is proving increasingly disconnected from reality for much of the world – we must face some uncomfortable questions:
Who are we ending AIDS for? Much of our current efforts appear specifically focused on heterosexual people in Southern and Eastern Africa. Yet within this region and throughout the world, millions are being left behind, particularly in key populations. How do we build an AIDS response that is both effective and equitable?
Why is prevention falling behind? We have an ever-growing list of effective prevention interventions but few resources to implement them. National programme planners have little room to accommodate prevention within their budgets and political leaders often lack the courage to tackle the questions that effective HIV prevention raises. How do we follow through from rhetoric to implementation of HIV prevention?
AIDS IS (STILL) POLITICAL
How should donor nations support the response to HIV in low- and middle-income countries outside of Southern and Eastern Africa? Repeatedly, we see countries transitioning from donor funding without the support to sustain the accomplishments of the past decade. Community systems wither and clinical care falters. What does responsible transition look like?
How ready are we, as the HIV community, to embrace other approaches to managing the epidemic? The HIV response has rightly built unique funding models and service delivery systems to address what was understood as a health emergency.
To sustain this momentum in an increasingly integrated world, we will need to work more closely with other aspects of health and social service systems. What is the optimal relationship between the HIV community and the broader global health and development fields?
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