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Ending AIDS by 2030: Challenges and Opportunities

By Emma Stockton

Last month, The International AIDS Society’s conference in Vancouver came to a close with an announcement that gave the global AIDS community great hope. In 2011, The United Nations had set a goal of treating 15 million people by 2015. That goal, once thought unrealistic, was reached 9 months early. Now more than 15 million people around the world living with HIV are receiving treatment.

On July 14, the United Nations announced the laudable goal of ending AIDS by 2030. As U.N. Secretary-General Ban Ki-moon said, “Ending the AIDS epidemic as a public health threat by 2030 is ambitious, but realistic, as the history of the past 15 years has shown.”

One major contingency for this goal that must be addressed is access to treatment. We have conclusive evidence that starting antiretroviral treatment as soon as a patient is diagnosed with HIV is proven to vastly improve patients’ health outcomes and prevent future transmission. We also know of a French teen born infected with HIV who received treatment until age 6 and has been virus free for twelve years.  This is the first confirmed long term remission for a child born with HIV.

However, despite the need to start treatment at diagnosis to be most effective, currently we are essentially rationing out ARVs to the sickest people because of their exorbitantly high cost. According to Medecins Sans Frontieres (MSF), more than half of the 37 million people living with HIV are not receiving treatment.

To end AIDS by 2030 we must either increase funding for treatment, achieve lower drug costs, or preferably both. As newer, second- and third-generation HIV treatments come on the market, they are often priced prohibitively high for scaling up treatment, especially in middle-income countries where a growing majority of people living with HIV reside. We urgently need more medicine at cheaper prices.

At the IAS conference, Johns Hopkins University Professor Chris Beyrer said, “Let this be the conference where the question of when to start treatment stops being a scientific question and starts being a question of finance and political will.” Governments have policy tools to introduce generic competition with patented drugs, which is the most effective way to reduce prices. But not all of them are adopting or using these resources.

Paradoxically, wealthy governments and the monopoly-based pharmaceutical industry continue to reduce access-to-medicines policy space through trade agreements and otherwise.

The Vancouver Consensus statement, organized by advocates signed by more than 500 clinicians, researchers, and HIV/AIDS civil society experts, emphasizes the need for access to treatment.

“Medical evidence is clear: All people living with HIV must have access to antiretroviral treatment upon diagnosis. Barriers to access in law, policy, and bias must be confronted and dismantled… We call on civil society to mobilize in support of immediate rights-based access to treatment for all.”

We cannot let the amazing progress of the past fifteen years end here. We must encourage governments and civil society groups to utilize what tools are available to push for cheaper generic drugs. The global health community must not allow pharmaceutical monopoly prices to prevent us from ending AIDS.

Emma Stockton is an intern with Public Citizen’s Access to Medicines Program