Comment and Analysis

We've been fighting Aids - now we must end it

Dr Mohga Kamal-Yanni, Urvarshi Rajcoomer

A critical prerequisite to ending Aids is for global leaders to improve the health systems of developing countries - including the drug supply chain.

The International Aids Conference wrapped up last week and high praise must be given to advocates and the scientists who have ignited momentum to shift from

The International Aids Conference wrapped up last week and high praise must be given to advocates and the scientists who have ignited momentum to shift from "fighting Aids" to "ending Aids".

This will hopefully urge governments and the pharmaceutical industry to make this vision a reality.

Increasingly effective medicines, new treatments for those who develop resistance or severe side effects and even a path for a cure were all amongst the good news at the conference. But to make this reality, pharmaceutical companies' donor governments must now do their part.

Scientific advances have shown the way for effective prevention and for treatment that saves lives and turns the deadly disease into a chronic condition. But pharmaceutical companies are dragging their feet and not granting licences to public bodies, such as the Medicine Patent Pool, that would enable production of affordable HIV treatment to all people who need it in developing countries.

While US Secretary of State Hillary Clinton has announced a substantial financial commitment on the part of the US to end Aids, her US trade representative is negotiating a trade deal that will in fact undermine such efforts.

By pushing for enhanced monopoly protection on new medicines, including medicines to treat HIV and Aids, US efforts will drive up the cost of medicines for people living in poverty, and the governments and agencies that seek to help them.

The financial crisis has been blamed for a decrease in global funding for HIV and health programmes and that forced the Global Fund to Fight Aids, Tuberculosis and Malaria to announce last year that it wasn't able to finance any new funding proposals until 2014.

This year, the Global Fund is discussing a new funding model that could lead to severe steps back in country ownership and aid effectiveness, forcing poor countries to go for what they can get, rather than what they actually need.

In South Africa we have seen that the most effective responses to HIV/Aids are contextual – the priorities of countries are derived from the ways in which the epidemic manifests in each country.

Programmes have to be tailored to meet the very real needs of communities. We cannot end Aids without global investment in a massive scale-up of appropriate prevention and treatment efforts, especially through the Global Fund.

We hope that the Global Fund board will reject top-down approaches and instead maintain the country ownership principal that the Fund prides itself on and truly delivers for those in need.

The initiative to achieve an HIV-free generation by stopping mother-to-child transmission is to be applauded.

Yet the lack of commitment of donors and governments to treating women before and after birth is appalling.

Furthermore, the lack of high-level political commitment from country leaders to remove prejudice, stigma and discrimination against the most vulnerable groups threatens to undermine the goal of Ending Aids. Prevention programs – both bio-medical and social – remain the mainstay of HIV and Aids response work.

Critical to the success of these programmes is ongoing awareness-raising and anti-discrimination work that allows the majority of people who need access to treatment and care to get it without being stigmatised.

New World Bank president Jim Kim made a splash at the conference, committing the organisation to playing a crucial role in ending Aids by focusing on what it does best: building health systems.

Oxfam believes investing in health systems such as infrastructure and health worker, drug supply chain and health information systems, is a critical prerequisite to ending Aids.

The World Bank should fulfil this promise by enabling developing countries – with help from other donors – to invest in free public healthcare and in supporting community-based care.

Dr Mohga Kamal-Yanni, Senior Health Advisor, Oxfam International

Urvarshi Rajcoomer, Advisor: Policy and Advocacy, Oxfam in South Africa

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