HIV & TB Response

Major UNAIDS U-turn: Finally recognises AIDS response in crisis

21st July 2016, Durban: The Treatment Action Campaign (TAC) welcomes the momentus U-turn made by UNAIDS this week at the 21st International AIDS Conference in Durban, South Africa. Prior to the conference, UNAIDS rhetoric overstated the likelihood of ending AIDS. We believe this overstatement has contributed to political and donor complacency regarding AIDS.

In a decisive break from their previous public statements, UNAIDS Executive Director Michel Sidibe this week said that the world is not currently heading toward an end to AIDS and Tuberculosis (TB) by 2030. At a press conference on Monday Sidibe said that he is scared about the future of the AIDS response. “I’m scared because I am seeing for the first time a decline in the financing from donor countries”, Sidibe said. “I cannot be dishonest with you, I need to say – we will have a resistance, we will lose our investment, we will have to pay more later … If we stop now, we will certainly regret (it) because we will see a resurgence in this epidemic.”

Together with activists from across the world TAC has highlighted this week that 20 million more people living with HIV need treatment now. The 17 million currently on treatment is not even halfway to the 37 million who need it. In addition, HIV still claims over a million lives per year and over two million people are newly infected every year. By any reasonable measure AIDS is a crisis.

At a thousands-strong march here on Monday we told leaders in the AIDS world that our AIDS response is at code red. We now have agreement on this issue from the United Nations body responsible for AIDS. In addition, various other leaders including former UNAIDS Executive Director Peter Piot and Stephen Lewis have also spoken out this week about the ongoing AIDS crisis and the danger of complacency and donor withdrawal. We urge other leaders in the AIDS world to also speak out forcefully about the crisis in the AIDS response and to lobby their governments to do more.

It is now up to world leaders, especially the heads of state of the G7 countries, to heed the call and to invest more political will and money in the global AIDS response.

It is a disgrace that we struggle to find the less than $30 billion per year required by the Global Fund, while hundreds of billions are annually spent on wars (the United States has an annual defence budget of $600 billion).

We also acknowledge UNAIDS’s ground-breaking recognition this week of the importance of community healthcare workers (CHWs) to the AIDS Response and healthcare systems more broadly. Sidibe said that the world needs to train and employ a million new CHWs internationally. He also said that South Africa, still the epicentre of the AIDS epidemic, requires 200 000 CHWS. This is five times as much as the 40 000 South African Minister of Health Dr Aaron Motsoaledi says is needed. We urge the South African government to implement this UNAIDS recommendation.

While the public statements from UNAIDS this week has overwhelmingly been positive, we remain concerned at the lack of focus on TB – the number one killer of people living with HIV and the number one infectious disease killer on the planet. Even worse than the funding gap for HIV, is the fact that the world can only find $0.7 billion per year for TB research – while the World Health Organization estimates $2 billion is needed.

Finally, while Sidibe has made some promising comments this week about the rights of marginalised groups, this work has to be taken much further than just comments in conferences. We urge UNAIDS to aggressively and publically name and shame countries with discriminatory laws. UNAIDS must initiate a highly publicised campaign to engage with countries about reforming discriminatory laws.

Below is a transcript of comments made by UNAIDS Executive Director Michel Sidibe at a press conference on Monday 18 July 2016.

Thank you, thank you my dear friend, your excellencies. Let me just start by just saying that I was privileged to have a boss like Secretary General Ban Ki-Moon. He is truly a man of social justice, of a fight for equity, without him we would not have two words. Central words in our Sustainable Development Agenda. The first word is dignity. Restoring dignity of people. The second word is leave no one behind. And I think that’s what brings us today to Durban. Because I remember 16 years back we were all struggling, wondering (not knowing(?)) what to do. The hospitals were full of people dying. And Nkosi Johnson called on us to make sure that treatment would be made available to all people and to not just have two classes of people –one in the north with the medicines and one in the south without anything except just time to wait to die. And today I am happy that we are back in Durban and we have been able to respond, passionately to this call. We have been able, in fact, to move from less than 1 million people on treatment to 17 million people on treatment today. We have been able to reduce, in only South Africa, by more than 84% the number of babies born with HIV in less than 5 years -which is just amazing. We have been able to put 3.4 million people on treatment in your country, which is the biggest programme of treatment in the world.

But let me say clearly to all of you, that I am scared.

I am scared because we are back again in South Africa in Durban in difficult times. The world is facing many other conflicting priorities. Terrorism, migration, so many issues that I am scared because I am seeing for the first time the decline in financing from donor countries. 13 out of 14 countries, secretary general, have reduced their contribution to the response. And I am scared because at the same moment I am seeing domestic resources being increased. Countries like SA are putting $1.6billion from their own budget. And if we continue with this trend, the only thing I want to say is we will not be able to end AIDS by 2030. The (… unclear …) is we will have a rebound in this epidemic.

And I cannot be dishonest with you, I need to say, we will have a resistance. We are losing our investment and we will have to pay more later. We saw that with malaria, we reached a level where we were able to think we controlled malaria; today we have to put a lot of money again because we stopped.

And I want to say also that I am scared because I am seeing the need to strengthen our health system. If we don’t have a strong health system, with the same system we have millions of community health workers will not be able to reach those people where they are, will not be able to give treatment to those millions of people who are waiting. And I am calling here for 1 million community health workers to be trained before 2020 and in South Africa  maybe 200,000 of them should be trained to make sure that we have an alternative service delivery system.

And I am scared because I am not seeing a decline in new infections amongst adults. And that is scaring me because we have 1.9 million new infections every year since 5 years ago and I am not seeing a decline in new infections amongst adults.

I am scared because I am seeing more young girls –like you said, young women –be infected.    And those are the issues this conference needs to address. We need to be able to call on donors to make sure that they can understand that it is not time to stop, if we stop now we will certainly regret it. Because we will see a resurgence in this epidemic and that is not what we want.

I am leaving here of course with the Ten Commitments which are coming from the High Level meeting which will help us to continue to push action. To make sure that we reach the 13 million people with treatment by 2020 we need to do that one. To ensure that 1.6 million children have access to treatment by 2018 because they are the forgotten face of our epidemic also and to ensure access to combination HIV prevention for all. I think that the calls which are in these Ten Commitments will certainly create a new space for us from now to 2020 to 2030.

I want to stop here but again, let us not forget, I don’t want to lie to anyone. I don’t see Zambia, I don’t see Malawi, I don’t see, even South Africa, alone, being able to put people on treatment and to reach the level we want to reach. If we don’t continue with global solidarity, if we don’t continue with shared responsibility, we will see unfortunately millions of people developing resistance, millions of people losing their capacity to a (… unclear …) this great success story.  

Thank you.