“This conference really begins to ask what we need to do differently, and how will we get there,” explains Nduku Kilonzo, Executive Director of the National Aids Control Council (NACC) of Kenya. Kilonzo is one of three day chairs to the Joep Lange Institute’s preconference at AIDS2018: meeting the 90-90-90 targets: faster and better. So, on what does the global HIV response need to focus to improve? A prominent panel of the current donor leaders: Amb. Deborah Birx of the U.S., Peter Sands of the Global Fund, Michel Sidibe of UNAIDS and Soumya Swaminathan of WHO, and advocates Rico Gustav of ICSS and Maureen Murenga discussed potential next steps and important take-aways from the global response thus far. Below follow a short summary of this panel discussion.
Mark Dybul, with Kilonzo and Lillian Mworeko day chair at the preconference, gave a short update on the financing side of the global HIV response before the panel took the stage: “There will never be enough money if we don’t get the infection rate down.” The two are intertwined and for that reason, it is important to re-think global strategies on treatment, prevention and financing, if we want to meet the target of ending AIDS by 2030. Dybul continues: “We are at the highest risk ever to lose control of the epidemic because of the demographics and because of countries not paying attention.”
Discussing the way forward
According to Michel Sidibe, executive director of UNAIDS “one of the biggest challenge is lacking resources. If we don’t pay now we will pay more later and later.” For him it is not merely a matter of increasing the volume of resources “but about being effective in terms of tailoring our response to realities of each epidemic.” Each country and key population requires tailored solutions, he argues.
Ambassador Deborah Birx from PEPFAR addressed the lack of political will of many national governments: “In most of the cases of middle income countries, South Africa being the exception, the issue is much more about the political will to address the epidemic that they have, versus the epidemic that they want to have. The resources are not aligned with the epidemic that they have.”
She continues: “In many of the middle income countries and upper middle income countries, the resources to comprehensively address the epidemic are there, but it is not the epidemic that they want to address. And I think, collectively as global community, we have to start being very specific about what these countries are and really have a discussion about that it is not about leaving people behind, it is about governments willingness to recognize that the people exist within the country.”
As pointed out by Wafaa el Sadr, director of ICAP at Columbia University, moderator of the session with Peter van Rooijen of ICSS, “It is not just about country ownership. It is about country responsibility.”
Universal Health Coverage
One potential way forward to a financially sustainable HIV response is Universal Health Coverage (UHC). Soumya Swaminathan, Deputy Director-General for Programs WHO: “We have Universal Health Coverage as overarching goal and everything else needs to fit in. We need to move away from disease specific vertical programs and think about what is the essential package of services that needs to be delivered. Not just treatment but prevention as well.”
Peter Sands, executive director for Global Fund, equally sees the value of looking at horizontal funding and perceives UHC as the desired outcome: “we really want to end the HIV epidemic and if we want to do this in a sustainable way, then it has to be built into a broader effort of building health systems; UHC and the underlying health financing mechanisms. And HIV has to be part of those financing mechanisms.” Yet, to develop UHC and retain the HIV response’s unique strengths shall be difficult: “We want to do it in such a way that it captures some of the strengths that the HIV response has demonstrated in the past years. We want the same focus in building health systems.”
Birx is more critical about the current UHC discussion: “The sense that UHC access and primary care is going to spontaneously occur, that if you build it people will come. I think we have a very clear evidence base that we have built it and they haven’t come. We have a very clear understanding who is missing.”
According to Rico Gustav, Senior Policy Advisor of ICC, currently civil society and communities are not involved enough in the whole UHC debate: “What are we talking about if we are talking about integrating HIV into UHC in countries that criminalize key populations. Services that are being provided will not be accessed by these people.”
Daouda Diouf – Ende Santé, Meg Doherty, MD – WHO, Wame Mosime – ITPC, Tsitsi Mutasa-Apollo, MD – Min. of Health & Child Care, Zimbabwe, Francois Venter, MD – University of the Witswatersrand
Geoff Garnett, Bill & Melinda Gates Foundation, Chris Beyrer, MD – Johns Hopkins University, Anna Dovbhak – EHRA, Jessica Justman, MD – ICAP, Wanjiro Mukoma – LVCT Health
John Simon, The Global Fund , Jonas Bargas – APCASO, Dr. Widyastuti Endro – Ministry of Health, Indonesia, , Carolyn Gomes – The Global Fund