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World AIDS Day 2013: a commentary

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On 1 December, people everywhere observe World AIDS Day. For the 26th consecutive year, we all pause to reflect – and to reignite the spark of energy and commitment that drives us to press forward until victory is in sight.

Once again, our moments of reflection reveal encouraging signs of dramatic progress – alongside clear reminders of the challenges still before us. 

This duality appears with a striking frequency, like two long strings of contrasting road markers on our path to victory. On one side of the road, a line of signs heralding promise. Stretching down the other, a set for challenge:

HIV remains a monumental global public health challenge. It has claimed 36 million lives to date; 35.3 million people now live with the virus. Nearly one in ten is a child, and 2.1 million are adolescents aged 10 to 19. . For these young people – the focus of this year’s theme – effective care is less accessible, and deaths among adolescents rose by 50% between 2005 and 2012, a period when overall AIDS-related deaths overall dropped 30%. 

HIV continues to strike hardest in low- and middle-income countries. Yet nearly ten million people are receiving antiretroviral therapy in those countries, a record, and the price of treatment has declined dramatically in many places. Globally, UNAIDS recently reported, we have seen a forty-fold increase in access to ART between 2002 and 2012.

However, almost 19 million other people now eligible for ART do not have access to it.

About 2.3 million individuals were infected with the virus in 2012. However, these numbers are  at the lowest levels since the 1990s.

 UNAIDS reports that stronger political commitment has produced greater global spending to defeat AIDS. Yet a funding gap continues.

 Finally, one constant we at The Union know too well: HIV is still the strongest risk factor for tuberculosis.  Last year, about 20% of the deaths from HIV – 320,000 people – were among people with TB.

HIV/AIDS is a vital part of The Union’s work. We help participating countries scale up their health-care systems and build capacity, including drug and equipment procurement. In Zimbabwe, our PEPFAR-funded pilot project involving 23 clinics in 17 urban areas is demonstrating that integrated TB-HIV care can be provided successfully through urban primary health care clinics. In high-burden Myanmar, The Union is one of that country’s leading providers of ART. Our IHC Programme treats more than 16,000 patients yearly, and we plan to double capacity next year. And yet, in 2013, only 40% of patients in Myanmar who need ART receive it. 

AIDS treatment is difficult work. The regimen is lifelong.  Supplies of medicine must be constant. Human resources for treatment are often inadequate in numbers or skill levels. Improvements are still needed in quality of identification and diagnosis; the world’s political commitment could be firmer.

The Union will continue to respond to these challenges by following the core values that guide our TB and other work -- quality, accountability, independence and solidarity.

We, on the front lines each day, may not need all the reminders of challenges and progress that World AIDS Day provides. But it is an important occasion nonetheless: Governments, civil society, the business community and the world’s people are all our allies in this great global effort. Today, we all stand together with resolve. We look, in unison, toward that place on the horizon where the finish line awaits.

Jose Luis Castro
Interim Executive Director
The Union