Getting to Zero: World AIDS Day 2011

Getting to Zero: World AIDS Day 2011

MSH in Cambridge, U.S. Dec. 1, 2011.


Today, in commemoration of World AIDS Day, I am in Japan at the University of Nagasaki School of Medicine, where I will speak about lessons from the fight against HIV & AIDS that can guide us in the fight against chronic non-communicable diseases (NCDs). As MSH’s 40th anniversary year draws to a close, it is fitting that I am here to meet Mrs. Iwamura, wife of the late Dr. Iwamura, who inspired MSH’s founding principles of humility and reciprocity, and to host a reunion of the Iwamura Global Health Fellows trained in the early 2000s through the Japanese Leadership Program. This year is not only MSH’s 40th anniversary; it is also 30 years since the first reported cases of HIV. Thirty years ago HIV was considered a new, always-fatal disease. No one knew what caused it, how to prevent it, or how to treat it. We’ve come a long way. Just ten years ago, only a few of the wealthiest people in the world had access to treatment. Just five years ago, we were only at the beginning of the massive scale-up of antiretroviral drugs that has proven so successful today. Today 6.6 million people—nearly half of those in need—will take life-saving antiretrovirals. The theme for World AIDS Day 2011 is “Getting to Zero,” zero new HIV infections, zero discrimination, and zero deaths. Today, the global movement for universal health coverage through health systems strengthening makes this goal a real possibility. MSH believes that only strong health systems—where all levels and sectors work together to provide integrated health services—will be able to provide the sustainable chronic care that is now needed as people with HIV & AIDS live longer. That same chronic care model will allow us to make headway against other conditions and diseases, including chronic NCDs—such as cancer, diabetes, heart and lung diseases—that are increasingly taking the lives of people infected with HIV and many others. Just among children, youth, and working-age adults, preventable chronic NCD deaths now account for 8 million deaths in low- and middle-income countries alone—more than the worldwide total 6 million annual deaths from AIDS, tuberculosis, and malaria. HIV and chronic NCDs are now united in necessitating chronic care: long-term follow up, re-visits, referrals, counseling, and social support systems. Both face many of the same challenges, including mobilizing high-impact prevention and realizing the right to health care. The HIV & AIDS work of the last decade suggests that chronic NCD efforts should seek to build a social movement, apply a rights-based approach to health, make drugs more affordable and available, remove stigma, and foster multi-sectorial partnerships. The chronic NCDs movement can learn a great deal from the HIV movement, but ultimately they must learn from each other going forward. While the number of new HIV cases each year is continuing to fall, there is still much work to be done to get to zero new infections. An estimated 34 million people are living with AIDS, and more than two-thirds live in sub-Saharan Africa. For both HIV and chronic NCDs, we must act in a coordinated and integrated way to effectively deliver prevention, care, and treatment. We must identify innovative service delivery models. We must apply creative financing models that engage the private sector, provide opportunity for risk sharing, and leverage existing health platforms. Here are just a few of the many ways MSH is collaborating with ministries of health and other local and international partners to move the world toward zero through stronger health systems:

  • The HIV/AIDS Care and Support Program (HCSP) in Ethiopia, which ended this year, facilitated the largest national expansion in Africa of decentralized HIV & AIDS services to health centers, serving approximately 30 million people (37 percent of the total population). Our current Ethiopia efforts will focus on the regions of Amhara and Tigray where nearly 50 percent of the HIV-infected population lives. HCSP represents the first large chronic care program for HIV & AIDS in Africa. Read the HCSP end-of-project report (PDF).
  • The Malawi Community-Based Family Planning and HIV & AIDS Services (CFPHS) project has had stellar success bringing integrated HIV and family planning services to rural areas. Now the Malawi Basic Support for Institutionalizing Child Survival (BASICS) project is supporting CFPHS through an innovative approach to preventing mother-to-child HIV transmission. The project offers lifelong antiretroviral treatment—not just temporary prophylaxis to prevent transmission to the baby—to all pregnant women, thereby protecting the health of the mother as well as the child.
  • The award-winning MSH-JSI Partnership for Supply Chain Management (PFSCM) remains the largest global procurement and distribution provider of antiretroviral drugs and related AIDS supplies through the PEPFAR/USAID Supply Chain Management System, which provides medicines for more than 1.5 million people in 19 countries, and through the Voluntary Pooled Procurement system, which procures medicines for more than 44 Global Fund countries.
  • • The Uganda STAR-E program, which expands HIV & AIDS prevention, care, and treatment through a family-centered approach in 9 regions of Eastern Uganda, has begun to integrate cervical and breast cancer services into its activities.

World AIDS Day: It's Not Over Yet.Today we celebrate our success as well as the success of our partners and all people working to prevent and treat HIV & AIDS. And we commemorate those lost to AIDS. In our U.S. offices we have hung red-ribbon banners and will host a vigil for those who have died. In our offices around the world, our staff are participating in national events and outreach activities aimed at those infected and at-risk for HIV. In Johannesburg, MSH’s Southern Africa Building Local Capacity Project will co-host a premiere showing of a Discovery Channel film telling the story of a soccer star living with HIV. With technical support from MSH and funding from USAID and other sponsors, the film educates its audience on the basic science of HIV & AIDS through an animated journey inside the human body. Today we also reflect on the work that is still ahead of us. In the coming week we will join more than 10,000 people at the 2011 International Conference on AIDS and STIs in Africa (ICASA) in Addis Ababa, Ethiopia. There MSH will host a reception, on December 6, to celebrate our 40th anniversary and discuss what more needs to be done to reverse the AIDS epidemic through health systems strengthening. Learn more about the event and RSVP on Facebook. Let us be encouraged by our success and by the momentum of the universal health coverage movement to carry on toward zero—zero infections, discrimination, and deaths—for HIV, chronic NCDs, and beyond. Jonathan D. Quick, MD, MPH, is President and Chief Executive Officer of Management Sciences for Health. Dr. Quick has worked in international health since 1978. He is a family physician and public health management specialist.