Elsevier

The Lancet

Volume 386, Issue 9989, 11–17 July 2015, Pages 171-218
The Lancet

The Lancet Commissions
Defeating AIDS—advancing global health

https://doi.org/10.1016/S0140-6736(15)60658-4Get rights and content

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Executive summary

After more than a decade of major achievements, the AIDS response is at a crucial juncture, both in terms of its immediate trajectory and its sustainability, as well as its place in the new global health and development agendas. In May, 2013, the UNAIDS–Lancet Commission—a diverse group of experts in HIV, health, and development, young people, people living with HIV and affected communities, activists, and political leaders—was established to investigate how the AIDS response could evolve in a

Section 1. HIV/AIDS today: still a major public health threat

Despite remarkable achievements in the past 30 years, HIV remains a major threat to public health. Although the latest available data and evidence show that the overall trend of HIV infection is generally decreasing, too many people are becoming newly infected with HIV, too many people do not know that they have HIV, and too many people are dying from AIDS-related causes. This is particularly true in major parts of sub-Saharan Africa and in various populations at high risk of HIV. With still

Section 2. What works: evidence and lessons from the AIDS response

Increasingly compelling evidence suggests that certain combinations of biomedical and behavioural prevention measures can successfully reduce AIDS-related mortality, new HIV infections, and mother-to-child transmission to very low levels and that these combinations can be implemented on a large scale in a cost-effective manner.56 Moreover, evidence is mounting of the power of prevention and treatment united with political, social, and structural interventions. Interventions that promote

Section 3. Win or lose: the AIDS response at a crossroads

This section presents our analysis of the effect and costs of four scenarios for what is possible to achieve in an AIDS response: a highly ambitious scenario agreed at the UN in 2014 that would bring the HIV epidemic to a very low level (Global Goals); two scenarios that would progress epidemic control (Best Case, Financial Constraints); and one scenario— in which current, already considerable efforts, are maintained—that would stagnate progress and allow a rise in the rate of new infections

Section 4. Better and smarter investments to control the HIV epidemic

The HIV epidemic has changed in the past 10 years: hospital wards are no longer filled with people dying of AIDS, most people living with HIV are treated on an outpatient basis, and in many countries, the epidemic is now more concentrated. The transition from a fatal disease to a chronic condition and from an emergency to a long-term maintenance response raises a new set of challenges, places different demands on countries, and necessitates new ways of thinking about effective approaches to HIV

Section 5. Research: an important foundation for a successful AIDS response

Scientific research has underpinned the AIDS response since the very first cases were reported in 19813 and must continue to do so. Here we look ahead at the scientific research agenda needed to achieve epidemic control and eventually eliminate HIV. But before discussing future HIV research priorities, we briefly describe the major funders of HIV research and highlight some general trends in HIV research funding.

Section 6. Beyond the grand convergence: AIDS and health

The scale of the AIDS challenge, coupled with waning political interest in single-disease programmes, demands that the AIDS response does things differently.175 The fundamental shift that needs to happen in the next phase of the response is to better tailor the response to people's needs and contexts, optimally use innovation, and address the structural drivers of this epidemic. In its fourth decade, the AIDS response must continue to transform both itself and the environment around it.

Much

Section 7. Towards long-term sustainable financing

Over the past 30 years, funding for the AIDS response in low-income and middle-income countries has risen from a few million dollars to $19 billion a year. Even during the global economic crisis of 2008–10, when financing from international sources levelled off temporarily, overall funding continued to increase thanks to growth in domestic contributions.187 Although overall HIV spending in 2012 and 2013 was close to the pre-crisis rate of expansion of $700 million a year, whether this growth

Section 8. Conclusion and recommendations

The main findings of our analysis are listed in panel 4. The next phase of the AIDS response must focus sharply on both prevention and treatment and on people who are at highest risk. The AIDS response must continue to be rooted in human rights and scientific evidence, build on the gains that have been made, and maximise synergies with other spheres of health and development. While mobilising additional resources, the AIDS response must remain true to its multi-stakeholder roots.

Only a massive

Conclusion

The question is no longer whether the fight against AIDS can be won; the only questions are: will it be won—and when? The answers to these questions will eventually depend on the decisions made by leaders and institutions at all different levels, in all sectors and parts of society, and on the personal choices people make in their private lives.

For the Stigma Index see http://www.stigmaindex.org/

This online publication has been corrected. The corrected version first appeared at thelancet.com on

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