The movement to confront the AIDS epidemic is a portrait in resilience that has led to one of the most extraordinary public health responses in history.
Thirty years ago, the 6th International AIDS Conference in San Francisco (AIDS 1990) was a perfect demonstration of the resilience of the HIV community. In 1990, San Francisco was being devastated by HIV, with thousands of people being diagnosed and hundreds of people dying each year in the absence of effective treatment. That same year, the rapid spread of HIV across sub-Saharan Africa was becoming alarmingly apparent with subsequent declines in life expectancy. In 1990, many scientific experts wondered whether HIV could ever be effectively addressed, projecting a future in which HIV rates would continue to spiral upwards.
At that moment of extreme peril, when little hope was on the horizon, scientists and people living with HIV confronted political and public health leaders as a united front in San Francisco, demanding answers for the inadequate response to a rapidly growing pandemic. The upwelling of solidarity and commitment at AIDS 1990 in a time of profound danger and uncertainty forced the world to see the reality of what was happening to people who were ignored and dying of AIDS-related causes, and pressured leaders to take action.
In the three decades since then, the resilience of the HIV community continued to be tested time and time again. Confronted with a new health threat, communities across the world created organizations that cared for the sick, worked to prevent new HIV infections, and advocated for greater action to combat the disease. In the face of a seemingly hopeless scientific and humanitarian challenge, scientists and activists joined together to accelerate the development of breakthrough treatment and biomedical prevention tools.
It is our unceasing collective passion and strategic action that has led to extraordinary advances that have saved millions of lives. We pushed for political commitments that led to the launch of the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria, the two largest funders of the global HIV response.
In the countries most affected by HIV, the union of scientists and community advocates led to increases in national budgetary commitments for health. We confronted AIDS denialism and helped unlock treatment access in low- and middle-income countries across the world – a feat once regarded as fanciful. In many countries, we forced political leaders to overturn repressive policies targeting people most vulnerable to HIV.
Today, the resilience that has taken us this far is being tested – this time, in new and different ways as the global health landscape is not what it once was. Now, we must come together and make common cause with other health issues while holding on to the key attributes that have made the HIV response so unique and so successful. We must ensure that we push forward integrated care and prevention approaches that will work for all people living with or at risk of HIV. Our ability to navigate this next phase of the HIV response, with the necessary adaptations in the current setting, is key to help set the emerging new generation of leaders on the path to future success.
As the 23rd International AIDS Conference (AIDS 2020) approaches, we must unite to face the challenges of a deteriorating human rights climate, repressive and punitive national laws in many countries across the globe, increasing xenophobia and social exclusion, and the widening gap between those with and without access to health services. We must use this moment to highlight our successes and address the gaps in the treatment, prevention and care paradigms to demonstrate the strength of our resilience.
AIDS 2020 is a call to action for:
- Resilience to meet the challenges of a rapidly changing global health landscape and to persevere in the face of uncertainty
- Resilience to insist on the fundamental human right to live with HIV in dignity and good health over a lifetime, to bounce back from adversity and to help each other in doing so
- Resilience to avoid fragmentation in the response and to remain united and inclusive in order to meet our common challenges
- Resilience to lead advocacy and programme implementation until new infections are stopped and everyone has access to prevention, treatment and the social support they need
- Resilience to advance science in order to find an effective vaccine, develop new prevention tools, improve treatment regimens, including generic options, identify additional effective behaviour-change strategies and ultimately to produce an affordable and accessible cure for HIV
- Resilience to fight against laws that codify stigma, discrimination and criminalization that restrict gender equality and access to human rights-based responses
- Resilience to join with advocates and scientists working on other health challenges and find common cause to advance universal health care worldwide
- Resilience to demand the long-term resources needed to achieve global HIV targets in a comprehensive global health agenda and to push back against short-sighted cuts to national and international budgets.