Universal Access to Treatment for HIV

Humanity’s struggle against HIV/AIDS began 30 years ago. The ensuing efforts to control the epidemic have not only saved lives but also given hope to millions of people. In the early years, nobody expected that treatments would advance so much in such a short time, or that they would become effective enough to change the natural history of the disease.

The global figures are heartbreaking. With more than 34 million people now living with the virus, the HIV epidemic remains a major global public health problem. In 2011 alone, 2.2 million people were diagnosed with HIV. Despite the great strides that have been made in HIV treatment, AIDS claimed 1.6 million lives in 2012.

Although remarkable progress has been made in controlling the disease, inequitable access to treatment has had a devastating impact on developing countries and vulnerable populations. As a critical step on the path towards universal access, the World Health Organisation (WHO) has set the goal of delivering antiretroviral therapy to 15 million HIV-positive people worldwide by 2015.

Meanwhile, the scientific community is working to develop diagnostic and therapeutic techniques capable of controlling the epidemic in the regions of the world that need it the most. ISGlobal plays a proactive role in the global research agenda for HIV/AIDS. Its research centre, the Barcelona Centre for International Health Research (CRESIB), has worked with the Manhiça Health Research Centre (CISM) in Mozambique to coordinate a number of research projects, including a large-scale study aimed at identifying the markers of acute HIV infection. The search for new diagnostic targets in the acute phase of HIV infection is a cutting-edge strategy for preventing diagnostic delay and the development of comorbidities. This particular study is one of several projects geared towards the fight against HIV, but it holds special importance for me because I had the chance to participate in it as a resident in preventive medicine and public health. I became a part of the CISM team’s day-to-day operations, caring for patients and participating in laboratory procedures. I was received so warmly that I felt right at home.

Through this project, I came to understand the multifaceted reality of HIV in Africa—the different faces of a disease that never ceases to pose research challenges. For the past 30 years, HIV research has been like a marathon run at a sprinter’s pace. The researchers on the CISM team forge ahead, motivated by the lives of the people living with HIV, their families, and all their hopes and dreams.

Meeting the targets set by the WHO will be a complicated and arduous task. Extraordinary levels of access to diagnosis, treatment, and prevention strategies will be needed if we are to reduce the number of AIDS-related deaths and new HIV cases to zero and root out discrimination towards people who live with the virus. Achieving these goals will require developing and implementing new solutions, which are certain to entail many more discoveries.

Now that I am based at the WHO headquarters in Geneva, I see things from a different perspective. Here I learned that UNAIDS recently published Access to Antiretroviral Therapy in Africa: Status Report on the Progress Towards the 2015 Targets. The advances outlined in this report will have a major impact on a population very dear to me: a ‘big little city’ north of Maputo that gave me the strength and drive to join a marathon that has been proving, for 30 years running, that humanity can better itself through science and knowledge.

César Velasco is a Clinical Fellow in Preventive Medicine and Public Health in the Preventive Medicine and Epidemiology Service at Barcelona’s Hospital Clínic. He completed a rotation at the Manhiça Health Research Centre (CISM) in 2013.