Partnering to Make Real Change in the AIDS Epidemic

What can I say about my first impressions of AIDS2012? It is overwhelming and moving. Over 23,000 people from all over the world are flooding from session to session and from exhibit hall to exhibit hall, all committed to ending HIV/AIDS.

A common theme among many speakers was that of partnerships. Without diverse groups working together, we cannot end this epidemic. During a presentation on Monday evening, “Rhetoric to Reality: Delivering Integrated HIV and Family Planning Service”, speakers talked about the need to fully integrate both family planning and HIV not just to refer to other services, but to join the two services. This joining must happen both ways: HIV must be incorporated with family planning services and family planning must be included in HIV services.

Additionally, many presentations stressed necessary synergies between different health areas to achieve better outcomes for HIV/AIDS as well as malaria, tuberculosis, and maternal health. But then, as I walked around the different booths and listened to each group’s particular issues, I saw how hard that task would be. Injection drug users from the U.S. seem to struggle to have their marginalized voices heard, whereas heterosexual women from Africa may struggle to access proper family planning services and Antiretrovirals (ARVs).

In the beginning of this epidemic, the culture of AIDS was distinct and represented a small, marginalized population in the U.S. Now there are an estimated 34 million people infected worldwide, and around 2 million HIV-related deaths per year. These statistics do not even touch the surface on the actual number it affects. In Africa we see the brunt of the infections in heterosexual women; in the U.S. we are still seeing high incidence and prevalence among men who have sex with men and injection drug users. If we consider just those two demographics and think about how to design programs and partnerships to truly affect change, the magnitude of the epidemic becomes clear. But with so many different people committed to fighting HIV and AIDS, it is great to see everyone in the same forum expressing this need for change and to work together.

Men who have sex with men may see a great need to move forward on issues such as Hepatitis/HIV co-infection and the advancement of rectal microbicides, whereas heterosexual women in south Africa (where rates are over 20% in some places) might be more in need of family planning services and PMTCT.

So who partners with whom?

The answer is simultaneously simple and complex. The right people need to partner to make the right change. Making those decisions should be put in the hands of those who need solutions most. In the international development context, HIV and AIDS programs are becoming more and more about health systems strengthening and are steering away from vertical programming. As the new World Bank President, Dr. Jim Kim, said at Monday’s plenary, “There is no one size fits all solution.”

I look forward to seeing how innovative partnerships combat the spread of HIV/AIDS.  From what I’ve seen so far, there is a great deal of hope for the future.