During a January 2017 lecture hosted by the Joep Lange Institute, Mark Dybul, HIV expert and former Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, spoke in detail about his own experiences working on the frontline of one of the world’s largest health crises.
Here are four ways he believes the fight against HIV/AIDS has shaped the future of healthcare provision for the better.
1. An increased role for data – and an insistence on results
Lecture transcript: The role of innovation and data in Global Health At the turn of the 21st century, Dybul recalls that all activity against HIV/AIDS was measured by only one metric – cash. “If you asked anyone … what are we doing in response to HIV… the answer would have been: ‘We’re spending X amount of money’.”
There was, says Dybul, a distinct lack of focus on achieving predetermined objectives or reporting the results of any activity. But the scale of the HIV/AIDS crisis changed the world’s thinking. In exchange for billions of dollars of funding, data systems were created and results were demanded.
Dybul remembers the criticism he faced from the global health and development community when the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), produced specific prevention, care, and treatment goals.
“They said: ‘Development is too complicated to set specific goals’. That’s absurd. Now there isn’t anyone who doesn’t talk about results-based development, results-based global health, and collecting data and results.”
He adds: “The insistence on data, accountability, responsiveness, and the need for results really was driven in a large part by HIV.”
2. A shift from paternalism to partnership
The West’s changing approach to development has also been triggered by decades of efforts against HIV/AIDS, says Dybul. Instead of providing instructions and orders, the West now takes a much more collaborative view.
He says: “For many, many years, development was largely: we are the smart, important people, generally white, from the North, who are going to come and tell you how to do things… That’s the way we did development.”
But by adopting a partnership approach, rather than the traditional paternalistic method, development projects were able to generate the accountability and responsibility needed to support national systems. These national projects were crucial.
Dybul says: “Paul Kagame (President of Rwanda) said something once, immediately after PEPFAR was created… that I will never forget. He said: ‘This is the first time someone has … respected us enough to hold us accountable.’ It’s a pretty extraordinary statement.”
3. A greater emphasis on equality as a key driver of progress“We can’t end the HIV epidemic unless we become better human beings.”
HIV/AIDS can only be truly tackled, says Dybul, by securing a series of equality reforms around the world. He says: “The people in the shadows, the people most marginalised and vulnerable in the society, have been the ones most susceptible to HIV.”
He points to gay men, the LGBT community, drug users, the urban poor, and adolescent girls and young women as those at highest risk of contracting HIV.
“We can’t end the HIV epidemic unless we become better human beings,” he says. “If we do it right, what will drive gender equality will be the response to HIV/AIDS, and that’s a pretty extraordinary thing for an infectious disease.”
4. The restoration of hope
Dybul lived in San Francisco when HIV/AIDS was at its height, but that experience still left him unprepared for the feeling of hopelessness spreading across parts of Africa.
“Entire communities were being wiped out,” he says. “There was no hope. It’s impossible to describe it unless you saw it. Everyone… was absolutely convinced they were going to die.”
But global progress – and success – in the fight against HIV/AIDS has transformed that outlook over the last 15 years.“We can remind ourselves that we’ve already achieved the impossible. And so, we can achieve the impossible again.”
“To see communities come back to life and believe they can do anything, because they tackled this epidemic, is extraordinary. It will drive enormous change around the world. That hope is one of the great legacies of HIV.”
Now, he believes the world can draw strength from the achievements made in the battle against HIV/AIDS – whatever challenges may arise in the future.
“We can remind ourselves that we’ve already achieved the impossible. And so, we can achieve the impossible again,” says Dybul.