Andrew Fullem, JSI and World Ed director of HIV/AIDS reflects on the changes in the landscape of the disease
World AIDS Day. It is that time of year again when attention focuses on the response to HIV, looking back at progress made and looking forward to the opportunities and challenges ahead. Much of the attention this year is positive, highlighting the unique opportunities before us. The UNAIDS annual report puts forward the lofty, but seemingly achievable goal of getting to zero: no new infections, no discrimination, no HIV-related deaths. Secretary Clinton’s recent speech putting forward the US government’s international response echoed many of the same messages: we have the science and tools needed to turn the tide of the epidemic, what is needed is the will. The response in the US, through the National HIV/AIDS Strategy places an emphasis on achieving measurable results with (and a renewed focus on targeting services for) those at greatest risk, particularly men who have sex with men, minimizing barriers to care and keeping people in care. However, tempered with the good news there are concerns. For the first time in years, the global economic situation and domestic budget battles have put U.S. and international HIV programs on the chopping blocks. There are challenges at the Global Fund, in management, implementation, and the willingness of governments to invest and meet their commitments.
I’m in a fortunate position, working on both domestic and international HIV programs. People often ask how one can shuttle between the two, given that the issues and available resources are so different. In fact, from where I sit, the differences really aren’t that great. For one thing, the focus must remain on engaging individuals and communities where they are, with programs that meet their needs, not just for HIV services, but broader health and social support services. There is a movement to medicalize the response, making clinics the “one-stop shopping” focal point of prevention, treatment, care and support services. While there are potential strengths in this approach, alone it will not completely turn the tide. In fact, we have had the greatest impact in reducing the number of new infections and enrolling people in care, be it in Massachusetts, South Africa or India, when community organizations and the medical establishment work in true partnership, focusing on the needs of clients. Community-based organizations, including associations of people living with HIV, have to be equal partners with the doctors and nurses who provide clinical care. Communities cannot be adjuncts to the medical response.
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Andrew Fullem is director, JSI & World Education Center for HIV & AIDS.