Via The Lancet: Beyond the silos: integrating HIV and global health. Excerpt:
This week, we publish a new International AIDS Society (IAS)–Lancet Commission report: Advancing global health and strengthening the HIV response in the era of the Sustainable Development Goals. Under the leadership of past IAS President, Chris Beyrer, and current IAS President, Linda-Gail Bekker, this Commission engaged an international group of experts in HIV and across other global health domains to examine the future of the AIDS response in the context of a more integrated global health and sustainable development agenda.
The Commission has several key findings. First, the HIV/AIDS community made a serious error by pursuing “the end of AIDS” message. As the Commission shows so clearly, the world is not on track to end AIDS. Although at the peak of the epidemic the incidence of HIV infections began to decrease and AIDS-related mortality fell, there has been no meaningful progress in reducing new infections during the past decade.
With 20·9 million people on antiretroviral therapy, the reality is that there is a large community of people today living with HIV. In 2015–16, an estimated 36·7 million to 38·8 million people were living with HIV worldwide.1 This community will continue to increase in size and, as the burdens of infectious and non-communicable diseases converge, they will need special attention and care throughout their lives.
Second, as the global community revitalises efforts on HIV, more of the same is not enough. In terms of HIV/AIDS funding, current trends point to a worrying decline. A study by the Institute for Health Metrics and Evaluation found that between 2000 and 2015, US$562·6 billion was spent on HIV/AIDS worldwide. Global HIV/AIDS spending peaked at $49·7 billion in 2013, and fell to $48·9 billion in 2015. Development assistance for HIV/AIDS reached its peak in 2012, at $12·0 billion, but has since declined by almost a quarter.
This finding is in stark contrast with the upward growth in development assistance for HIV/AIDS between 2000 and 2012. Given how many low-income and middle-income countries are dependent on development assistance for health to fight HIV/AIDS, further reductions will make these countries even more vulnerable in the longer term.
Also, it is time to question the notion of AIDS exceptionalism. The Commission acknowledges the exceptionalist approach to HIV might not be sustainable. We strongly agree, and would go further. The AIDS exceptionalism message is now hurting the AIDS response, not helping it.
Third, and perhaps most importantly, it is now time to end the siloed and vertical response to AIDS, and, in the words of the Commission, to “make common cause with the global health field”. That conclusion raises many questions about the existing instruments to address the AIDS epidemic—namely, UNAIDS, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the US President's Emergency Plan for AIDS Relief (PEPFAR).
We invite these major institutions that are instrumental in driving the AIDS response to reconsider their purpose and their future. We encourage their respective leaderships to reassess their missions and to move towards a broader global health purpose, while at the same time sharpening their commitments to HIV/AIDS. With an upcoming replenishment in 2019, the Global Fund should continue to push hard for extra funding for HIV/AIDS.
But the Global Fund should also think about how to broaden its response to include wider aspects of global health. This approach would support the idea that investing in the AIDS response is a means to building stronger health systems, getting to universal health coverage, and deepening access to services beyond HIV/AIDS.