It is about time someone with a high profile media presence challenged the facile phrase "The End of AIDS" or "AIDS Free Generation". Too bad Dybul didn't challenge it when he was deep inside the institutions spouting them.

But he has nailed it here. Can the Global Fund respond? Or will it be business as usual?

Jamie

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Ending HIV as an Epidemic

Scientific advances and years of implementing programs have given the global community the historic opportunity to end the HIV pandemic. Yet traveling that last mile will require smarter investments, setting more refined epidemiological targets and focusing on the most vulnerable people. In an address to a conference in Vancouver last month, Mark Dybul, Executive Director of the Global Fund, urged partners in the fight against the disease to work together to seize the historic moment and use all the tools available to have the greatest impact in a more intelligent way. “The goal we can and must have today, what we must entirely focus on, is ending HIV as an epidemic and turning it into low-level endemicity,” Dybul said.

Twelve years ago, when the Global Fund was founded, the HIV response was centered on stopping death and as many new infections as possible, so targets in the fight against the disease were set with that reality in mind. Massive investments on the ground and a better epidemiological understanding of the disease have changed the landscape dramatically, allowing us to be bolder as we look to the future. Dybul argued that to achieve the goal of ending the HIV epidemic, it is essential to have equity and to address the people at greatest risk of becoming infected with HIV: women and girls, sex workers, people who use drugs, men who have sex with men, transgender people, people in prison and migrants.

Because HIV exists in hotspots – pockets of higher transmission and infection rates – bringing the HIV epidemic under control will mean moving beyond the “tyranny of averages” and target instead those specific geographic areas and marginalized populations most affected by the disease, Dybul said. “We have to look at geographies and we have to look at populations, those most at risk to ensure that we have equity. We have to bring the epidemic under control in all of those sub-geographies and sub-regions and all populations and key affected populations,” Dybul said. Otherwise, we will continue leaving people behind and miss an historic opportunity to bring the epidemic under control.

In his address, Dybul also urged partners to set aggressive goals both for the care and treatment for those who have HIV in all geographies, sub-geographies and for all affected population, but also because of the preventive benefit of treatment, since an HIV-positive person on treatment reduces the risk of transmitting the virus by up to 90 percent. Moving forward with all the prevention tools would also help us achieve our goal. “If we come together to utilize the resources well, if we take advantage of this historic moment, there is no doubt in my mind that we can end this epidemic and that we can be free from HIV as a public health threat, not only on nation by nation or worldwide averages, but in every sub-region, every sub-geography and for every key affected population.”

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