Act now on AIDS

Abstract

“We cannot know why the world suffers. But we can know how the world decides that suffering shall come to some persons and not to others”. The words of Guido Calabresi and Philip Bobbit (Tragic Choices, 1978) reveal the inescapable reality that the global community faces as it strives to scale up treatments for HIV/AIDS internationally. While an increasing number of nations and international bodies are joining the fight to increase access to antiretroviral drugs, the US Institute of Medicine reminds us of how daunting this task is.In addition to the array of ethical dilemmas this agenda bears, such as deciding who will and will not receive limited treatments, the sobering analysis contained in Scaling Up Treatment for the Global AIDS Pandemic describes the many logistical challenges the international community must face in order to halt the devastation caused by untreated HIV disease.Much optimism has been generated by the announcement of funding initiatives that aim to scale up antiretroviral treatments. There has also been remarkable success in the provision of antiretrovirals in resource-poor settings. But if you thought the suffering associated with untreated HIV disease will be resolved by current initiatives, this book will make you think again.Scaling Up provides an independent review of antiretroviral treatment scale-up programmes underway and in development. The review, which shifts frequently in tone from dry and discouraging to passionate and optimistic, highlights how efforts to scale-up HIV treatments are susceptible to various threats, such as interruptions in funding, drug supply, and massive deficits in human resources and related infrastructure. The Committee repeatedly reminds the reader that a failure to address these challenges could result in widespread treatment failure and development of resistant virus, and by consequence, a declining enthusiasm for scale-up efforts among funders. These warnings may, however, create the impression that the need to “act well” may overwhelm the imperative to “act now”. This impression persists even as the Committee avoids other sensitive but related issues, including objection in many settings to best practices in HIV prevention for intravenous drug users, controversial US policies about abstinence-only prevention programmes and generic antiretroviral drugs, or the seemingly disproportionately large sums of money currently devoted to fighting terrorism.Although a daunting task, scaling up HIV treatment is achievable and necessary with sufficient political will. Let's hope that the summary of lessons outlined here ensures that imperative to act now is realised. “We cannot know why the world suffers. But we can know how the world decides that suffering shall come to some persons and not to others”. The words of Guido Calabresi and Philip Bobbit (Tragic Choices, 1978) reveal the inescapable reality that the global community faces as it strives to scale up treatments for HIV/AIDS internationally. While an increasing number of nations and international bodies are joining the fight to increase access to antiretroviral drugs, the US Institute of Medicine reminds us of how daunting this task is. In addition to the array of ethical dilemmas this agenda bears, such as deciding who will and will not receive limited treatments, the sobering analysis contained in Scaling Up Treatment for the Global AIDS Pandemic describes the many logistical challenges the international community must face in order to halt the devastation caused by untreated HIV disease. Much optimism has been generated by the announcement of funding initiatives that aim to scale up antiretroviral treatments. There has also been remarkable success in the provision of antiretrovirals in resource-poor settings. But if you thought the suffering associated with untreated HIV disease will be resolved by current initiatives, this book will make you think again. Scaling Up provides an independent review of antiretroviral treatment scale-up programmes underway and in development. The review, which shifts frequently in tone from dry and discouraging to passionate and optimistic, highlights how efforts to scale-up HIV treatments are susceptible to various threats, such as interruptions in funding, drug supply, and massive deficits in human resources and related infrastructure. The Committee repeatedly reminds the reader that a failure to address these challenges could result in widespread treatment failure and development of resistant virus, and by consequence, a declining enthusiasm for scale-up efforts among funders. These warnings may, however, create the impression that the need to “act well” may overwhelm the imperative to “act now”. This impression persists even as the Committee avoids other sensitive but related issues, including objection in many settings to best practices in HIV prevention for intravenous drug users, controversial US policies about abstinence-only prevention programmes and generic antiretroviral drugs, or the seemingly disproportionately large sums of money currently devoted to fighting terrorism. Although a daunting task, scaling up HIV treatment is achievable and necessary with sufficient political will. Let's hope that the summary of lessons outlined here ensures that imperative to act now is realised.