By Chris Collins (amfAR - Vice President and Director, Public Policy)
In 10 years, will we look back on President Obama's 2011 World AIDS Day speech and see it as a turning point in the AIDS pandemic, or cringe at the lost opportunity of a singular moment? The president's December 1 speech could be pivotal, but only if it is followed by changes in how we tackle global AIDS.
Why was the Obama speech important? The president declared that "we can end this pandemic," calling out the enormous potential following 18 months of startling scientific progress on AIDS. He laid out ambitious new targets for delivery of effective interventions, which, if accomplished, could substantially reduce rates of HIV infection and mortality. And in setting those targets, Obama signaled a renewed U.S. commitment to funding for global AIDS programs at a time when resources at home are constrained and other countries are backing away from the fight.
Now it's time to plot a course for implementing the president's vision. We need to act quickly to take advantage of reinvigorated leadership, aligning resources for tangible impact. Four things are critical to success and deserve immediate attention: strategic decision-making, increased funding, balancing global targets with attention to the most vulnerable, and research.
First, a new era of efficiency and strategic resource allocation is needed. An increased share of AIDS resources needs to reach programs on the ground, and that funding needs to be used for maximum impact. An AIDS-free generation requires a shift in resource allocation approaches; ideally, each country would start each year with a clean-slate budget and determine how to use money most effectively based on the latest science, epidemiology, and evidence of impact.
We also need to more widely and better used economic modeling to make evidence-based decisions about recourse allocation. These models are increasingly influential, and they need to be designed thoughtfully. Choosing the questions and assumptions that are punched into the computer makes all the difference. It is not enough for models to focus simply on how we might reduce incidence when the goal of the global AIDS response is broader: to reduce infections, morbidity, and death.
No one intervention in isolation will move us toward an AIDS-free generation; it's going to take a combination of approaches. That said, using a more strategic lens will lead to changing priorities. For example, in countries where the epidemic is largely centered on certain populations investments should be focused there. Regardless of epidemic profile, investments in all countries should be submitted to this test: What public health impact can they be expected to achieve?
The new AIDS treatment target set by President Obama in his December 1 speech captured most of the media attention, but the president set specific goals in four areas that day: treatment, voluntary medical male circumcision, prevention of vertical transmission, and condom delivery.
Those four interventions will be central to any successful campaign against AIDS. Other interventions will be necessary, too, including behavior change, syringe exchange, and structural approaches. And it's long past time to better integrate TB, sexual and reproductive health, and other services with AIDS programming.
But now that the HPTN 052 study has conclusively demonstrated that AIDS treatment dramatically reduces the likelihood HIV will be passed to a partner, scientific leaders are pointing to treatment delivery as a central ingredient of progress. While more research is needed to understand the population-level prevention impact of AIDS treatment, there are already signals worth noting.