​‘Closing the HIV treatment gap won’t be easy and it will take a global effort’

Sixteen years ago, as South Africa prepared to host the International Aids Conference, HIV drugs were saving hundreds of thousands of lives in developed countries but millions in the developing world went untreated. Prospects for treatment in Africa seemed distant. The medicines were too expensive, funding too little, capacity on the ground too limited.

Yet that conference turned out to be the tipping point of the global HIV treatment access movement. In its wake, the global community introduced lifesaving programmes and committed billions of dollars. Some pharmaceutical companies — including Gilead Sciences, where I work — took important steps to accelerate access to treatment. Gilead’s HIV treatment access programme, which licenses our drugs to generic companies in India, South Africa and China, is now the leading source of HIV medicines in the devel- oping world.

As a result of that collective humanitarian effort, the number of people receiving HIV treatment has increased from 690 000 to 17-million, including nearly 10-million taking generic versions of Gilead drugs. But simple math will tell you that 20-million people living with HIV still do not have access to treatment.

As South Africa once again hosts the International Aids Conference, for all the progress made in expanding access to HIV treatment — and the progress has been extraordinary — we still have much work to do. It can be difficult to see the path forward, but to reach all those in need, the global community must recommit to finding solutions.

We do have a rallying call. The global community has established the ambitious goal of “90-90-90”: that 90% of people living with HIV are aware of their infection; 90% of those diagnosed with HIV are on treatment; and 90% of those on treatment have their virus fully suppressed.

Scientific progress offers new hope for slowing the epidemic and reaching these targets. Pre-exposure prophylaxis (PrEP) — the use of HIV medicines by uninfected individuals to reduce their risk of infection — holds great promise. South Africa, for example, was the first African country to approve PrEP, and the health ministry’s guidelines for its use among high-risk populations has the potential to prevent a substantial number of new infections.

Gilead supports the roll-out of PrEP to adolescent girls and young women in Africa through the United States government’s Dreams (Determined, Resilient, Empowered, Aids-free, Mentored and Safe women) initiative. In addition, research toward an HIV cure has accelerated in recent years, although the virus remains an elusive target, and a cure is still many years away.

Realising the 90-90-90 vision and the potential of scientific advances will require a new mobilisation of national and international resources that includes funding, people and political will. The Durban conference is a critical opportunity to build on the legacy of 2000 and renew the global commitment to provide HIV treatment for all those in need.

The pharmaceutical industry has a critical role to play, and that is where my primary focus lies.

Although our generic licensing programme has driven treatment costs to historic lows, we can explore other avenues for making treatment more accessible and affordable. For example, Gilead recently launched in the US a medicine that is effective at a much lower dose than its predecessor and therefore less expensive to produce. A study by the Clinton Health Access Initiative projects that this and other new HIV medicines have the potential to reduce cumulative treatment costs in developing countries by up to $3-billion by 2025.

But no one group can transform HIV treatment alone. We know from experience that government invest- ments in HIV prevention and treatment can save millions of lives and billions of dollars in future costs. Today, the Global Fund is seeking donor pledges to ensure that it can meet its obligations of $13-billion over the next three years, and the US government’s Pepfar (President’s Emergency Plan for Aids Relief) initiative continues to be a critical source of treatment funding in many countries.

Closing the HIV treatment gap won’t be easy, but we know from previous experience, including in South Africa, that extraordinary progress is possible. I am optimistic that this International Aids Conference will mark another turning point in the epidemic, in which the world recom- mits itself to closing the HIV treatment gap.

Gregg Alton is the executive vice-president of Gilead Sciences.

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