“Ending Aids” is the new slogan in the HIV and Aids realm. It has been enshrined in the Sustainable Development Goals (SDGs) as part of goal three on disease control that stipulates; “By 2030, end the epidemics of HIV and Aids, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases”.
Understandably, there has been varied interpretation, and by extension, mixed feelings towards this aspiration. Is it just policy rhetoric? What does ending Aids really mean?
This aspiration has a background. The eight MDGs, to which the world committed to in 2000, have shaped the health and development discourse of the past two decades. Of particular interest to the HIV and Aids sector, MDG 6.1 presented an enormous challenge having reflected the goal: “to have, by 2015, halted and begun reversing the spread of HIV and Aids.” The goal was considered audacious and seemingly out of reach.
However, owing to commitment and advances in science, the world has collectively achieved the seemingly insurmountable. Heartwarming achievements abound. For example, new HIV infections globally, have reduced from an estimated 3.1 million in 2000 to two million in 2014. Barely 10 000 people were on Anti-retroviral Therapy (ART) in sub-Saharan Africa in 2000. To date, more than 16 million people worldwide are on ART and up to 7.8 million deaths have been averted due to increased ART coverage.
Historic achievements of the past 15 years of the HIV and Aids response in the MDGs era have provided the impetus to pursue a more ambitious goal of ending HIV and Aids as a public health threat by 2030. Granted, the operational definition of Ending Aids entails, reducing new HIV infections, stigma and discrimination experienced by people living with HIV and key populations, and Aids-related deaths by 90 percent from 2010 levels, such that Aids no longer represents a major threat to any population or country.
One would argue that ending entails to completely cease, and in this case meaning that there are no new HIV infections and Aids related deaths. This literal understanding remains the ultimate goal as expressed in the three zeros: Zero new infections; Zero Aids related deaths and Zero Stigma and discrimination. But can we really end Aids as a public health threat by 2030? Does the E nding Aids discourse resonate with Malawi?
Yes, in the context of myriad health system and socioeconomic constraints, Malawi has achieved a lot and is lauded internationally in many aspects of HIV epidemic control. Malawi pioneered Option B+ plus to prevent mother to child transmission of HIV and has achieved the highest reduction in vertical (mother-to-child) transmission of the 22 countries identified as priority countries in 2011. It has successfully increased ART coverage with 585 660 people alive and on ART by September 2015 from about 23 000 in September 2005.
Malawi needs to reduce new HIV infections from 65 000 per year in 2010 to 6 500 in 2030 and reduce Aids related deaths from 51 000 in 2010 to 5 100 by 2030. On evidence of successes in Malawi, Ending Aids as a public health threat is a possibility.
We have reached a defining moment in the Aids response and have a wonderful opportunity to bend the trajectory of the epidemic. To galvanise this aspiration, world leaders are attending a UN High-Level Meeting on Ending Aids in New York from 8th-10th June. The discussions focuses on a political declaration on importance of a fast-track approach to the Aids response over the next five years as a pathfinder to ending Aids by 2030.