Closing the gaps to end AIDS, tuberculosis and malaria
In 2015, the world is seizing hope from the progress we have all made towards ending AIDS, tuberculosis and malaria. Since 2000, together we have driven down the global malaria mortality rate by 47 per cent, saved the lives of more than 37 million people with tuberculosis and brought new HIV infections down by almost 40 per cent. This year, we will reach the Millennium Development Goal (MDG) of ensuring that 15 million people have access to antiretroviral therapy for HIV. Much of this progress can be credited to the leadership of the G7, from the establishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria to its commitment to universal access to HIV treatment, which is the key to ending the AIDS epidemic.
Yet a long journey still lies ahead. Today, the world faces the greatest challenge yet to ending the epidemics of AIDS, tuberculosis and malaria by 2030. This challenge is to close several yawning gaps that remain.
First and foremost, no one must be left behind. Too often, aggregate numbers showing progress mask the inequity beneath the surface. Unless efforts shift towards responding to the pockets of risk and disease burden in specific communities – geographic and social – all efforts may stall, and progress may disintegrate. This is not just a matter of public health, but one of social justice. It is a human rights imperative. As Eleanor Roosevelt, when drafting the Universal Declaration of Human Rights, reminded us all so eloquently: “Where, after all, do universal human rights begin? In small places, close to home – so close and so small that they cannot be seen on any maps of the world. Yet they are the world of the individual person; the neighbourhood he lives in; the school or college he attends; the factory, farm or office where he works. Such are the places where every man, woman and child seeks equal justice, equal opportunity, equal dignity without discrimination. Unless these rights have meaning there, they have little meaning anywhere.”
The way to reach the targets for AIDS, tuberculosis and malaria is to go deep and far, to reach into the back streets of cities where sex is being sold, or where people are hiding because they are afraid of being deported, or sleeping rough because they are homeless. We need to reach into prisons, refugee camps and slums. Unless we do so, we will fail. We must act immediately, not only for this generation but also for future ones, or else AIDS, tuberculosis and malaria will remain risks to all of us. Inequalities will be further exacerbated, generating societies that are fragile and divided.
Changing this requires starting with the very basics. Shockingly, approximately one-third of births are not registered each year across the globe. But birth registration is the first step towards having an identity. It opens the door to the enjoyment of a wide range of human rights: to access healthcare, go to school, inherit money or property, and to vote or stand for elected office. We need to ensure that everyone is counted by investing in structures, systems and technologies for civil registration and vital statistics record-keeping.
Moreover, people must be free to be who they are and not have an identity imposed upon them. In the HIV response, for example, safeguarding the right to gender identity is a pressing priority. Today, most transgender people lack legal recognition of their affirmed gender, which excludes them from education and employment. They often face discrimination, violence and lack of access to appropriate healthcare. Consequently, the chance of acquiring HIV today is 49 times higher for transgender women than for all adults of reproductive age.
Women and girls must be front and centre of all efforts. It is unacceptable that AIDS remains the largest killer of women of reproductive age. Adolescents are another population group that needs to be prioritised. AIDS is the second leading cause of death among adolescents aged 10-19 years globally, and the leading cause of death among adolescents in Africa.
And the list goes on.
The G7 can lead the way in ensuring that the Sustainable Development Goals (SDGs) take us all towards inclusive and people-centred development. Making sure that everyone is counted is a prerequisite.
Closing the healthcare gap
For far too long, healthcare delivery has been organised around diseases and biomedical approaches. Let us embrace universal health coverage as an important stepping stone towards a human rights-based approach to health that pays attention to the cultural, economic, social and political determinants of health – how people live and work and how they access political power, protection and resources. Connecting all of this – weaving a net to capture everyone in need – is a long-standing value of the AIDS response.
Across the three diseases of HIV, tuberculosis and malaria, we must all be prepared to address the inequalities, discriminatory practices and unjust power relations that are often at the heart of ill health. The capacities of people to take control over their own lives must be reinforced. The G7 members, as leaders among the international community, need to be bold in supporting efforts to hold governments to account for addressing discrimination and embracing health as a fundamental human right.
Closing the investment gap
Macroeconomic policies are key to addressing inequalities. But it is not just a matter of more money – investments must be diversified to make funding sustainable and tackle the ‘beyond aid’ issue. This will require strategic collaboration with all major funders, and the leveraging of G7 investments more effectively. It will also require mobilising new, innovative sources of finance, including taxes, remittances and trust funds, and maximising the roles and contributions of civil society, including through increased investment in this vital resource.
The G7 must not ignore the marginalised in middle-income countries, where people continue to struggle under high disease burdens while external funding is being withdrawn. Although development partners must and will continue to provide the tools, knowledge and advocacy that enable countries to shed the shackles of dependence, they must not turn away from their responsibilities to countries that need time and continued support to become more self-sufficient.
Another concern is the tension between trade rules and human rights in the context of access to medicines. Solutions can be found rapidly, keeping affected communities as the priority.
Closing the governance gap
These last 30 years of AIDS have shown how closely social inequities are linked to inappropriate or inadequate systems, bad laws, discrimination and other tools of exclusion. These factors drive the spread of preventable diseases. People are left behind because laws, policies and practices exclude them – because they are poor. Because they are gay. Because they have a disability. Because they are not a citizen or do not speak the language. Because they are addicted to drugs. Or, simply, because they are young or female in a society that does not value them.
In 2015, it is clear that the global health architecture and the global health frameworks that began the MDG journey are antiquated. I urge the G7 to lead the way to a new development paradigm that promotes effective, accountable and transparent institutions, supported by inclusive decision-making that engages affected communities.
People are increasingly aware that they are ‘rights holders’, not objects of charity. They are demanding access to quality health systems as an entitlement, and are raising expectations on governments to exercise leadership and ensure governance systems that are inclusive and tackle inequalities.
To close the gaps in global systems, and between people moving forward and those who are being left behind, UNAIDS is looking to the G7 for commitment, collaboration and support.
