The Hindu : Opinion / Leader Page Articles : AIDS: the next agenda

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Saturday, Nov 13, 2004

Opinion

Opinion - Leader Page Articles

AIDS: the next agenda

By Peter Piot

Unless the cycle of infections that feeds the disease is stopped, treatment will prove unsustainable.

THE INTERNATIONAL AIDS conference held in Bangkok in July 2004 witnessed intense debates around the response to AIDS. Although prevention was widely discussed, it was not the central issue it used to be. It became clear during the conference that the theme "Access for All" really meant treatment. For sure, massive scale up of treatment programmes is a moral and practical imperative — it will save lives and protect the economies of many countries by keeping alive their most productive populations. India too, has announced plans to roll out treatment. Yet, prevention will still need to remain the first line of defence in its quest to stop the spread of the epidemic.

India has to acknowledge the implications of greatly expanded access to anti-retroviral treatment. Hundreds of thousands will need to remain on treatment for life. New infections will add hundreds of thousands more to the `treatment list' each year. Unless the cycle of infections that feeds the disease is stopped, treatment will prove unsustainable and the goal of universal access will be only a dream.

Today fewer than one in five persons worldwide has access to HIV prevention services. The time has come to reinvigorate prevention efforts and to move beyond the current, reactive methods. And simply adding the `V' for vulnerable groups to the important "ABC" prevention approach is not enough (ABC stands for abstinence, being safer, and correct and consistent condom use). India has painfully learnt that in the past few years as shown by the steady increase in HIV infections among women. Much longer term strategies are needed.

First, information and awareness will not be enough to address the plight of women in India. Close to half of those living with HIV worldwide are women and young girls. They are more vulnerable to infection than men because they are disempowered. Women's rights must be translated from an ideal into legal reality.

Secondly, the youth of India must be protected. India has nearly 200 million young people. Most of them have little access to prevention programmes and services. Protecting them at the very least includes promoting girls' education, increasing employment opportunities, reducing child exploitation and abuse, reducing stigma and discrimination, and creating an enabling environment for youth participation in decision-making.

Thirdly, national and State Governments together with donors, multilateral organisations should recognise that prevention is not the unscientific, feel-good issue best left to NGOs, community and faith-based organisations. Preventing the spread of AIDS is a science and must be embedded in every aspect of the national response to AIDS.

Each prevented infection means one less person to treat, thereby easing the pressure on health systems.

HIV prevention is a classic "public good" — it is needed by whole communities, but, unlike treatment, there are few immediate profit incentives for the private sector to be involved. Governments, State and Central, must take responsibility for making prevention available. Only with stepped up commitment on treatment and prevention can the AIDS epidemic be controlled.

(Dr. Peter Piot is Executive Director of the Joint United Nations Programme on HIV/AIDS, UNAIDS, and Under Secretary-General of the United Nations.)

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