The proverbial development aid “pie” is getting smaller, yet the global burden of HIV is not.  However, 30 years after the first cases of AIDS were described in the 5 June 1981 issue of the Morbidity and Mortality Weekly Report, the latter is not entirely bad news.  

As more people living with HIV access antiretroviral drugs (ARVs)—the drugs that are used to control replication of the virus and to improve the immune system of the infected individual—more people are living longer, productive lives.  New infections and AIDS-related deaths are both decreasing.  This is great news, but challenges remain and the enthusiasm with which the world took on HIV at the turn of this century must not wane. 

UNAIDS and the global community have a goal of “zero”:  zero new HIV infections; zero discrimination; and zero AIDS-related deaths.  The UNAIDS’ 2011 World AIDS Day Report talks about how to get to this goal faster, smarter and better. In today’s economic climate, perhaps the most relevant adjective is efficiently, as it is unlikely that billions of dollars will be allocated to the fight against one disease that predominantly affects low-resourced countries for many decades to come.  But that is all right—it has to be—because we have learned a tremendous amount about what works and what doesn’t in the past 8 or more years.

Here are the facts:

• There are an estimated 34 million people living with HIV globally, approximately the same number of people that live in the largest state in the United States (California).
• Women are disproportionately affected in sub-Saharan Africa, where they account for 60% of the 23 million individuals living with HIV.
• Nearly 20% of people living with HIV in the world live in one country—South Africa.
• Tuberculosis (TB) is the leading cause of death for people living with HIV, and unless this treatable, airborne disease is addressed in concert with HIV, zero AIDS-related deaths is impossible.
• Despite tremendous efforts, there were an estimated 2.7 million new infections in 2010, the same number of people that live in Chicago.
• Misinformation drives discrimination. Just this week in China, three schoolteachers were denied jobs because they are living with HIV as “civil servants should not be carriers of an infectious disease.”
• Voluntary Male Medical Circumcision prevents transmission from females to males.
• Antiretroviral therapy saves lives and prevents transmission of HIV to children and to partners.

MCHIP has been instrumental in assisting Ministries of Health and institutions of higher education to equip health care providers, those who educate them, as well as those soon to be deployed with the skills they need to prevent, diagnose, treat, care and support communities affected by HIV and TB. When it comes to healthcare workers, emphasis is on ‘the backbone’ of the healthcare system in sub-Saharan Africa (if not the world)—namely, nurses and midwives. In Mozambique, a woman who seeks contraceptive services because she has decided she wants to be in control of her fertility would receive services from a midwife.  In Tanzania, a young man wishing to be circumcised to protect himself from contracting HIV would receive services from a nurse.  In South Africa, an HIV-infected pregnant woman would receive HIV treatment for her own health and for the prevention of transmission to her unborn child from a nurse. 

Today, on World AIDS Day 2011, MCHIP would like to pay tribute to all of the front-line health care providers, especially the nurses and midwives, for their daily dedication and hard work to keep their communities healthy in the face of numerous challenges. For being the ones who have always “integrated services” by being the only healthcare provider caring for whole communities, particularly in rural settings.  For being the ones to implement combination HIV prevention before the phrase was even coined.  For being the ones who cared for their patients dying of AIDS less than a decade ago. 

Because there is no ‘getting to zero’ without them, no matter how big the pie is.

Stacie Stender
Africa Regional Technical Advisor in TB/HIV/Infectious Diseases, Jhpiego