“No Excuse” for neglecting 10 million people with HIV

Governments must commit to massively scale up treatment at UN Summit on AIDS

Governments will meet at the United Nations in New York for an HIV/AIDS Summit from 8 to 10 June, to discuss the global response to the epidemic over the next five to ten years.  Hanging in the balance will be the lives of the ten million people in urgent need of treatment, at a time when the latest science tells us that treating HIV not only saves lives, but also dramatically reduces transmission of the virus from one person to another – by 96%.

Ten years ago, at the first major UN meeting on HIV/AIDS, then- Secretary-General Kofi ANNAN called for a ‘war chest’ to respond to the epidemic.  The decade that followed saw an unprecedented mobilization of political will and funding to put six million people put on life-saving antiretroviral drugs (ARVs).  But much more is needed to break the back of the epidemic.

MSF began treating HIV/AIDS in 2000, and has seen the tremendous positive effect treatment has had on people and communities, reducing deaths and illness.  The introduction of ARVs has transformed HIV from a death sentence to a manageable chronic disease.  More and more people are receiving treatment – now more than six million in developing countries – and there are now new tools, treatment strategies and innovations that can help reach even more people.  

One major factor that allowed treatment scale-up to today’s levels was the fact that the price of ARVs dropped dramatically over the past decade, from more than US$10,000 in 2000 to roughly $150 today.  This price decline has made lifesaving drugs accessible to millions of people in developing countries. The newer generation of ARVs has fewer side-effects, which has a positive effect on people’s ability to adhere to their treatment.

Another factor that has helped expand treatment is bringing care closer to patients, to local community clinics and health posts.  This has particularly improved access to treatment for people in remote rural areas, who otherwise would struggle to find time and money to travel to distant central hospitals. Innovative models where patients are empowered to play an active role in managing their own treatment has also helped solve some of the issues related to distance, and has helped alleviate the burden on health systems. Moreover, shifting tasks from doctors to nurses, and in turn from nurses to lay workers, has reduced the pressure on overburdened health staff without compromising on quality of care.

The lessons learned over the last decade have shown us how to reach people with care in developing countries.  The World Health Organization now recommends people receive better-tolerated medicines, earlier in their disease progression, before they become very sick.  This is an important step in the right direction.  And there are innovations on the way that could help us more easily reach even more people.  New drugs and innovative formulations; ways of producing drugs that could bring their cost down; simpler and easier-to-use diagnostic tools to monitor how patients are doing on treatment – these will help make the job of scaling up treatment even more feasible.  

But all of this requires political will – this cannot be done without the financial resources from international donors and domestic investments in the countries affected. Scaling up treatment to all people in need will only be possible if leaders honor their past commitments by providing sustained funding, and by ensuring that drugs are affordable and available. Leaders also need to support policies to put effective treatment strategies in place and support the research and development of better, more affordable and simpler-to-use medicines and medical tools.

The job is far from finished.  The lessons of how to reach more people with care, coupled with the critical new science that shows us treatment can help us get ahead of the wave of new infections, tell us that now is the time to push forward with ambitious plans to get treatment to people in need.  There is simply no excuse for politicians to neglect the ten million people who will die without treatment in the next several years.