On World AIDS Day: Keeping Up the Fight

Every December 1, on World AIDS Day, the global community pauses to take stock of clinical, research, and community efforts to combat HIV and AIDS, and to remember the millions of people we have lost in the epidemic’s first three decades. This year, new data from UNAIDS show that a lot of progress has been made—and in some compelling new areas.

At the epidemic’s peak in 2004, 2 million died annually from HIV-related causes; by 2014 that number fell to 1.2 million. More people are receiving treatment now than ever: as of June 2015, nearly 16 million people living with HIV worldwide were accessing antiretroviral therapy. In addition, the number of new HIV infections has declined by more than a third in the last 15 years. In the United States, new prevention tools, including Pre-Exposure Prophylaxis, or PrEP, have been embraced which offer great potential to decrease the number of new infections among American gay men, a group that remains severely affected by the epidemic.  

But to end this disease for good, the world must press ahead, says Wafaa El-Sadr, University Professor and director of ICAP at Columbia University, based at the Mailman School. “There’s a lot to celebrate this World AIDS Day, but now is not the time to rest. So much more needs to be done: we must maintain global commitments, resources, and momentum—it’s the only way forward.”

Just a few weeks ago, representatives from ICAP’s country teams flew to New York to map out their way forward for the coming year. With programs in more than 21 countries, ICAP is a global leader in tackling the world’s most pressing health needs, including the HIV/AIDS epidemic.

At the annual ICAP Leadership Meeting, which took place from November 16-20, country teams came together to share lessons learned, present research and ideas, and map out plans for the coming year. Many staff met face-to-face for the first time, and through panels, discussion sessions, poster presentations, and other events, common themes and focus areas in the fight against AIDS emerged. One of these themes was building the capacity of the healthcare workforce, especially in nursing.

Training Nurses, Helping Vulnerable Groups, MeAsuring Progress

“Nurses are really the foundation of everything that happens in healthcare in many of the countries where we work,” says El-Sadr. In Cote d’Ivoire, where HIV/AIDS treatment and prevention has until recently been almost entirely carried out by doctors, ICAP’s team is building the case to support nurses and community health workers to be a greater part of the effort; one way they are doing this is by collecting data to illustrate how effective nurses are. Aiming to address the insufficient number of skilled nurses in their health workforce, ICAP is working in Zambia and Lesotho to train new nurses and midwives. By focusing on core competencies, the team developed new curricula in collaboration with ministries of health including one that reduces midwife and nursing training time from six years to less than four years.  

Across ICAP’s programs, country teams are implementing interventions and measuring their results to understand which work best. One successful project focused on increasing the involvement of male partners in supporting their HIV-positive pregnant partners. In another, ICAP’s teams implemented a suite of interventions to strengthen the continuum of care; too often, HIV testing is done in a separate location from HIV care, leading to a situation where patients know their status but fail to reach the care that they need.  

Another major ongoing ICAP effort is assessing the big picture of HIV in some of Africa’s hardest-hit nations. Conducted in close collaboration with ministries of health, the U.S. Centers for Disease Control and Prevention, and local stakeholders, survey teams are collecting information and conducting laboratory tests to estimate the magnitude of the HIV epidemic in adults and children and to measure the degree to which populations can access prevention, care, and treatment services. This effort was launched in Zimbabwe and Malawi earlier in the fall and just a few days ago in Zambia, with additional countries to be added in rapid succession over the next two years. The result of these Population-based HIV Impact Assessments (PHIAs) will guide HIV programs over the next decade. 

In the United States and around the world, efforts to fight HIV have begun to zero in on specific underserved, vulnerable populations—men who have sex with men, people who inject drugs, adolescents, migrants, sex workers, among others. In meetings and panel sessions, ICAP representatives shared, compared, and contrasted innovative approaches and special treatment and prevention programs aimed for these populations. From ongoing work in Central Asia with persons who inject drugs, to efforts to engage men who have sex with men in South Africa, Mali and Democratic Republic of Congo, ICAP representatives gained new insights into how to successfully prevent HIV infection as well as how to manage HIV patients suffering from profound stigma and discrimination.

Working locally and globally, many ICAP staff members rarely have the opportunity to share experiences and to debate the many challenges they face. Being together offers the chance to learn from each other and to put faces to names. “While there are always some challenges that are unique to a region or population,” El-Sadr said, “I think we can take lessons learned from one another and adapt to each other. Today, this kind of cross-border, cross-continent learning is more important than ever.”

Despite many promising numbers in the fight to end HIV/AIDS, one fact stands out—more than two million people were infected with HIV last year, and only an estimated 40 percent of the people who need HIV treatment are actually getting it. On World AIDS Day, ICAP serves a reminder that maintaining momentum, working together, and learning from each other are all keys to fighting the disease and ending this epidemic.