Realpolitik tells us that the era of AIDS exceptionalism is past. Post 2015, determinedly fighting for a stand-alone response to AIDS simply will not work in most contexts. Yet a stand-alone, fully resourced and ambitious response is worth fighting for in many countries, especially those that continue to face hyper-epidemics such as the southern African countries, where more than 25 per cent of the adult population continue to live with HIV.
As we move forward into our fourth decade of AIDS, it is time to review the place that AIDS occupies in national and global structures and make sure that the institutional arrangements don't simply reflect a boilerplate that is the same across countries. The principles of inclusion, justice and equity that led to the creation of this global movement must guide the future of the AIDS response, and support the wider bold ambitions of the post-2015 environment.
The AIDS movement is often in the spotlight, heralded for the massive achievements since the condition was discovered in 1981. The future response must build on the core foundations: the centrality of people living with HIV, the reach to all sectors, a laser focus on human rights, grounded in a public health paradigm, recognising the breadth and depth of impact of this virus, and with the nimbleness and flexibility to evolve and adapt. And these foundations are easily adaptable to other pressing priorities - notably maternal and child health - that have found themselves in the spotlight in the past decade. Standing firm for the future means rejecting the idea of a grand development plan or simple structure as the panacea to all problems. Indeed, this is precisely the premise of the MDG era. And as we reach the end of that era, it is time for organic, variegated structures to emerge.
The power of the AIDS movement is palpable. We should be proud that we have transformed how people living with other health conditions conceptualise themselves and are able to fight for their rights and their visibility. The current challenge is two-fold: to share learning from the successes (and failures) of the AIDS movement to build equally powerful responses to women and children's health, and other health and social justice priorities while at the same time maintaining the right level of sustained focus on AIDS and avoid premature claims of "Victory!"
What we need to guide us forward is a return to the basics. We need to go back to the principles that have always guided the fight against AIDS: the respect for human rights, the insistence on participatory processes, engaging all sectors, and commitment to the leadership and meaningful involvement of the people who are most affected. It is these principles that must define what happens next. If we fold structures deeper into a health context, then this must be based on the multi-faceted approach of public health, driven by the people seeking to achieve it, not just strengthening a clinical system led and owned by doctors.
Dr Jonathan Mann - the first global AIDS leader, who established WHO's Global Programme on AIDS in 1986 - pressed for a response that linked health and human rights, seeing AIDS as an important pathfinder that would shift the dynamic forever. His vision remains an important guide. He insisted that all sectors must work together and rejected a simplification of the response that would merely focus on the bio-medical or cluster all health issues together. This is the solution that has been proposed by some, yet poses a real risk of losing the focus on human rights and the broader impact.
Some are rushing to dismantle the current AIDS architecture, forcing multi-sectoral National AIDS Councils into unholy alliances, for example merging into generalist health councils. The hasty integration of issues that have different needs and priorities is unlikely to lead to success: resources will need to be fought for and won again or the epidemic will rebound. This does not mean that we must stick with the current structures - in some contexts, the separatism and complexity of the structures are no longer appropriate, and this must be addressed.
Those of us who have been part of the AIDS response for decades know that now, more than ever, AIDS matters: it continues to matter for the 35 million people globally who live with it each day; it matters for the millions more who are vulnerable to infection, and lack the personal skills, community spirit, resources and political support to protect their health; it matters that we share our passion, and our learning with other health and social justice movements who share that same passion to protect other communities and populations from equally grave threats to their wellbeing.
And it matters that our responses are worthy of the millions who have already lost their lives to this plague.
This is an abridged version of a chapter focused on the AIDS architecture, from AIDS Today: Tell no lies and claim no easy victories, the first edition of a new biennial publication that presents the state of the civil society response to AIDS. Published by the International HIV/AIDS Alliance, the report aims to spark reflection on how best to set aside resources for civil society; how to make the case for new approaches to AIDS; and how to support the next generation of AIDS governance mechanisms at global and country levels.