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The Director's Corner

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World AIDS Day: Following the lead of the 2001 High-Level Meeting on HIV/AIDS

In the last week, leading up to World AIDS Day on 1 December, I have had the privilege to meet with the communities, staff and volunteers working on The Union’s Integrated HIV Care (IHC) Programme in Myanmar.

In 2005 The Union launched a small project to provide integrated care for patients co-infected with TB-HIV living in Mandalay, Myanmar. That year 190 patients received treatment including antiretroviral therapy (ART) free of charge.

Last year, the programme provided ART to more than 29,000 people with HIV living across five regions of the country, and has become a key component of Myanmar’s national HIV strategy.  IHC patients receive ART and medicines to treat opportunistic infection free of charge at clinics that screen for TB, monitor CD4 count and HIV viral load and provide expert counselling.

This has only happened thanks to unique and dedicated collaborations at every level - including the tireless work of thousands of volunteers, the integration with in-country programmes, and an 11-year funding commitment to people living with HIV from TOTAL E&P.

It makes me think back to the year 2001, when five years after ART was first announced at the International AIDS Conference in Vancouver the drugs were still only available to the privileged West.  At the United Nations (UN) High-Level Meeting on HIV/AIDS, which was the first time heads of state from around the world gathered to solve an international health crisis, a firm commitment was made to bring life-saving treatment to people living with HIV the world over. This lead to the creation of the Global Fund to Fight AIDS, Tuberculosis and Malaria and gradually generic pharmaceuticals began producing antiretroviral drugs more cheaply. The tide started to turn.

There is still a long way to go, but AIDS deaths have fallen thanks to the global HIV/AIDS community uniting around an urgent call to action and finding the political leaders and funders to not only make promises but to deliver on them.

Unfortunately, the same cannot be said for tuberculosis (TB) that is now the world’s leading infectious killer – 1.6 million people die every year.

The World Health Organization (WHO) declared TB a global health emergency in 1993, and yet 25 years later 10 million people a year are still getting TB. More than one million children under the age of 15 fall sick to TB every single year and, of these, 239,000 – nearly one in four – die.

To end TB, we need an urgent, massive scale up in donor funding for TB, country ownership of TB programmes, and a huge fast track for TB research and development - TB will not be eliminated unless we have better diagnostics, better drugs and an effective vaccine.

According to the WHO, we have needed a pipeline of at least 18 new TB drugs and yet our reality is that in the last 50 years only two new TB medicines have come to the market. The same lack of progress can be seen with vaccines where we still look to the BCG as the current vaccine option, a vaccine from the last century with limited efficacy.

And there has been a global failure to address TB in the context of the HIV epidemic, despite the evidence that HIV infection increases, by up to 30 times, the likelihood of latent TB progressing to advanced disease. Still we see HIV and TB services often working in silo and uncoordinated.

This must all change. It is up to us to make this change happen.

In September we saw the first ever UN High-Level Meeting on TB take place. It is staggering that this has not happened before but vital that it happened now. It led to the adoption of a Political Declaration, with specific, measurable milestones to achieve by 2022. 

By adopting this declaration, national leaders have said they recognise TB as a challenge they are essential to solving. They have committed to taking specific actions. The day to begin implementing this new agenda begins now.

My hope is that just as the 2001 UN meeting on HIV/AIDS helped turn the tide on the HIV epidemic, so the High-Level Meeting on TB and the commitment of us all involved in the TB community will bring an end to this terrible disease. But this will only happen if we can now translate the promises of this year to action.