In last night’s David Cooper Lecture, Dr Beatriz Grinsztejn, President of the International AIDS Society (IAS), said that while “the world has the tools to end AIDS as a public health threat by 2030”, the global community must come together to fill critical funding gaps and sustain action on HIV if the World Health Organization’s 2030 target is to be achieved.
In conversation with ABC’s Dr Norman Swan, Dr Grinsztejn outlined the current global challenges in meeting the approaching targets, particularly in light of the withdrawal of United States funding to global HIV and AIDS funding bodies, PEPFAR and USAID. Discrimination, stigma, and access to lifesaving HIV prevention and treatment also persist.
“We need to confront structural challenges,” said Dr Grinsztejn. “So not only persistent stigma, but social exclusion, late diagnosis and very uneven access to high quality services across regions and populations.”
Global funding challenges
To contextualise where global action on HIV and AIDS is today, Dr Swan asked Dr Grinsztejn to reflect on the early days of the HIV pandemic.
“In those days HIV was not just a virus; it was a mirror reflecting who we were as a society,” she said. “Many of the first people I cared for were gay men whose lives were devastated not only by an illness for which no treatment existed, but also by prejudice and rejection. The suffering I witnessed was not only biological but deeply social. People were dying from lack of medicines, yes, but also from loneliness, discrimination and the system totally unprepared to care for them.”
It was during this time that she learned to view “medicine as a field where science and justice must walk together.”
It is on this backdrop that global collaboration, cooperation, and funding systems were developed. PEPFAR, or the President's Emergency Plan for AIDS Relief, was established in 2003.
Dr Grinsztejn explained that PEPFAR has been responsible for the majority of PrEP (the highly effective HIV prevention medication) access globally. But with the US funding cuts, which came into effect in January this year, PrEP supply has been limited to pregnant women only, meaning that many population groups at risk of HIV are left without.
The broad global funding model of PEPFAR has been replaced by bilateral agreements between the US and specific countries, presenting an opportunity, but with critical gaps. The new agreements, she said, focus on financing health care workers and HIV antiretroviral treatments, but concerningly, leave out community-run non-governmental organisations, which under former global funding models provided the majority of HIV care, especially in countries where homosexuality is highly stigmatised and even illegal.
“A lot of the work was done by community health workers and this is totally out of the new financing structure. So HIV care is being integrated into regular care in these countries where the cuts were major and it's always very hard to talk about integration of HIV services into the regular services, especially in places where criminalisation of homosexuality is in place.”
“It's a very critical moment and this is certainly already impacting HIV new infections and HIV related deaths, especially among children,” said Dr Grinsztejn. “But also it is impacting severely the roll out of new prevention technology – long-acting antiretrovirals.”
“There is a huge global public health risk and it’s all about safety; we need to invest because it’s safe for the entire planet.”
Priorities to meet needs now and into the future
While there has been a reliance on US funding for global health, Dr Grinsztejn pointed to other funding sources such as The Global Fund, as well as the opportunity that the new bilateral agreements present for countries to set their own resourcing priorities. “Countries have the opportunity to put together their agenda where the resources could fit best to strengthen their own health systems. This affirms the principle of national ownership,” she said.
Dr Grinsztejn said that science and manufacturing should be among the highest priorities, to allow countries to manufacture medicines locally, and once the infractructure is set up, much more cheaply. She drew on the example of the COVID-19 pandemic, during which those countries that had capacity to manufacture vaccines locally were ultimately able to vaccinate their populations and bring the pandemic under control much more quickly.
Referencing her home country, Brazil, Dr Grinsztejn said that US investment via the National Institutes of Health (NIH) “brought us conditions to do truly amazing, important research,” as well as facilitated global HIV clinical and vaccine networks. These will need to be bolstered into the future, along with – importantly – platforms for community voices to be heard; an initiative that the IAS prioritises.
“The world has the tools to end AIDS as a public health threat by 2030. What is missing is sustained political will, predictable and adequate funding and the courage to confront inequity head-on. We also need to preserve investment in science and in preparing the new generation of scientists to continue the work,” she said.
Ultimately, Dr Grinsztejn said we ought to be optimistic, because of the immense progress that has been made over the four decades since the HIV pandemic began, thanks to global collaboration.
“The HIV response that was born from activism, solidarity and science remains one of humanity's greatest collaborative achievements. So to preserve it, we need we must protect what works. Invest in what is new and never forget who is most at risk of being left behind.”
Norman Swan in conversation with Kirby Institute Director, Scientia Professor Anthony Kelleher
Paying tribute to a pioneer in HIV research and advocacy
To open the event, Dr Swan asked Kirby Institute Director, Scientia Professor Anthony Kelleher, to reflect on the legacy of the late Scientia Professor David Cooper AC.
“David Cooper was all about health equity through evidence,” said Prof Kelleher. “He did that by identifying strategic interventions that would make a difference across all communities for all patients, but that had to be based on scientific rigor. He managed to bring together elegant scientific approaches with community consultation on a global basis to come up with solutions that were not just practical but highly accessible. And those interventions still underpin many of the approaches we have to treating and preventing HIV to this day.”
Dr Grinsztejn, who had also worked with Prof Cooper, also emphasised his human rights-based approach to health science. “His legacy continues to shape the way many of us think about science and solidarity. David believed that science was not only about discovery, but also about responsibility to communities, to equity, and to the global sharing of knowledge,” she said.