Towards 2015: Part One

Before we even know it, those of us working in the field of global health are well and truly going to be caught up in the debate around the Millennium Development Goals (MDGs) whose target end-date is 2015.

Before we even know it, those of us working in the field of global health are well and truly going to be caught up in the debate around the Millennium Development Goals (MDGs) whose target end-date is 2015. Truth be told, we already are to a certain degree and it is my hope that this week's discussions on the road towards the MDGs at the UN in New York are productive. But while in New York I'll be just as interested in the conversations around the post-2015 scenario and more precisely where HIV/AIDS will fit in the broader scheme of things in the second half of this decade and beyond.

To date there hasn't been very enough obvious and collaborative discussion - certainly not openly nor publicly - on just how we'll approach HIV/AIDS post 2015. I'd like to offer up some early thoughts:

Of course, I believe that HIV must be mentioned in any post 2015 global UN roadmap but at the same time many of us are also comfortable with the idea that HIV/AIDS may fall under a broader global health goal and feel the time is ripe for that evolution.

There needs to be more emphasis on the capacity of health systems in local settings to be better able to deliver integrated services that reflect client need rather than donors' needs. Of course the two do sometimes meet, but the impact of donors on programs' design, priorities and outcomes is still often bigger than that of client needs - as we all know, this too often leads to failure of programs, and donors rarely take the blame.

Evidence based collaborations between HIV scientists and researchers and those working across disciplines should be further encouraged. On some fronts, HIV cure research has already involved working alliances with cancer specialists, for example, under the auspices of the International AIDS Society and the National Institutes of Health in the U.S. It is now becoming increasingly apparent too that the fields of paediatrics and HIV will also have a great deal in common in the coming years, specifically in terms of research around potential new drugs.

It is risky NOT to be talking NOW about 2015 amongst ourselves. The IAS is determined that there is an ongoing productive debate and that that debate is communicated widely. To that end we are ensuring that post-2015 scenario discussion is prominent in the Melbourne AIDS 2014 conference programme, as the International AIDS Conference is a unique arena for all stakeholders to meet, including people living with HIV/ AIDS.

Key Affected Populations (KAPS) MUST be included in any post-2015 agenda. We need to ask ourselves WHY there is an unstated reluctance amongst some to prioritise a conversation on why sex workers, men who have sex with men (MSM), people who inject drugs (PWID) and transgender people in certain parts of the world are inhumanely being excluded from accessing treatment, care and prevention services.

Is it because by discussing the issues around these people we are, at the same time, acknowledging our collective failure some of the time to get it right when it comes to vulnerable groups? I wonder too if the reluctance to look the issue in the eye might have something to do with a new generation of political leaders who might fear that affording any prominence to Key Affected Populations endangers their political survival, in part due to electoral attitudes. The Malaysian government know this experience well - its national implementation of harm reduction programs in 2008 to address an HIV/AIDS epidemic being largely driven injecting drug use was at the time hugely controversial but most importantly it was the right thing to do. New HV infections amongst PWID in Malaysia are now able to be controlled much more effectively that previously was the case. To not have focused on this Key Affected Population would have been discriminatory and quite simply, bad policy.

If we are to move forward post-2015, there simply HAS to be some measured reflection on how collaborations between professionals beyond the HIV field can become a reality and on why some populations are too often being left behind in the response to the HIV/AIDS epidemic. We then need to move discussion forward on how we need to do things better/differently/more efficiently so that everyone has universal access to treatment care and prevention, something we all have long believed in.

Bring on New York!


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