United Nations General Assembly recently held its annual AIDS review to follow up on the commitments from the 2011 Political Declaration. During a side event organized by the UNAIDS at the UN Headquarters in New York on June 6, Kelly Thompson, an AIDS activist and a member of the PACT, spoke on her vision for ENDING AIDS.
Other prominent leaders who spoke at the event were: The UNAIDS Executive Director, Michel Sidibe, who spoke about his vision to End AIDS and John Stover from Futures Institute on “Is it theoretically possible to End the HIV epidemic as a public health threat by 2030?”
Here is Kelly’s speech:
I have grown up in a generation that has never known a world without AIDS. Six months before I was born, Gallo and his collaborators published in Science about the retrovirus that they believed caused AIDS. In 6 months, I will be welcoming a new niece into the world. It is audacious and brash, and perhaps a bit naïve, but I believe we can end AIDS before her 16th birthday. I am not alone, in March, 1000 medical students gathered in Hammamet, Tunisia to discuss health in the post-2015 agenda. The result of this was a document enshrined as “The Hammamet Declaration”, which called for governments to commit to finish the unfinished MDGs, including setting new ambitious targets to get to the end of the AIDS epidemic.
Again, medical students are not alone. As part of The PACT, a collaboration of 25 youth organizations working on HIV, over 180 community dialogues were organized worldwide. These dialogues allowed young people everywhere, including those in marginalized and vulnerable groups, to express their wants for post-2015. Two key messages were apparent throughout all of those dialogues:
1. Secure a commitment for universal access to sexual and reproductive health & rights and harm reduction services
2. Secure a commitment to ending the AIDS epidemic by 2030.
Now, as a pessimistic optimist, I believe this can only be done if we accelerate our current work, and more specifically if we accelerate our work around young people and adolescents and the numbers agree with me.
AIDS-deaths have been on the decline globally, but HIV-related deaths among adolescents have increased between 2000 and 2012, with most of the cases in sub-Saharan Africa. In 2012, nearly 100,000 adolescents died from HIV-related causes. Globally the second leading cause of death of adolescents is HIV/AIDS. The African Region has by far the highest adolescent mortality rates. HIV accounts for 16% of this, and 90% of the world’s HIV-related deaths in adolescents occur in this region. Globally, HIV is the leading cause of death for adolescent girls – compared to 2000 when it wasn’t even in the top 5 causes of death. In Sub-Saharan Africa, young women aged 15-24 are 8 times more likely than young men to be HIV-positive. To me these aren’t just numbers on a piece of paper, they are telling me something is seriously wrong: that young people in this moment are experiencing a public health emergency and something needs to be done about it.
All of these statistics however come with a strong caveat, that there are large data inconsistencies for young people. So for me the first step in ending AIDS – with a focus on young people – is getting age disaggregated data that allows us to have a full picture of what is happening to young people. Having this information will allow us to develop more targeted programming and to monitor and evaluate progress here.
A key idea that is demonstrated by the successes of the HIV response is that health doesn’t live in isolation. When creating the Hammamet declaration we realized that the end of AIDS could not be achieved without addressing larger issues like inclusion of vulnerable and marginalized populations, gender equality, sexual and reproductive health and rights, the social determinants of health and intellectual property rights. All of these, when not addressed, serve as barriers to accessing health services, and for me and every other young aspiring physician it disables us from providing the best care possible to our patients.
I mentioned earlier, The PACT, our collaboration of 25 youth organizations. We like to think of ourselves not only as a think tank, but also as an action tank. The group is exciting for me because it allows me to step outside the walls of my clinic and to truly engage with the community. It brings together young people living with HIV, young medical students, young advocates and activists, young peer educators, young treatment experts and young members of key populations – giving all of them a voice. And like I said we don’t only like to think about the HIV response, but following the mantra of not for us without us, we have identified key areas of action that we believe are essential in ending AIDS.
Firstly, we believe that HIV services need to be integrated into sexual and reproductive health services and policies. A key area where this is evident is in comprehensive sexuality education, or CSE. CSE has a strong evidence base that it delays sexual debut, reduces the frequency of sexual activity, reduces number of sexual partners and increase condom and contraceptive use.
The PACT also believes strongly in harm-reduction for young people and that it should be included in HIV National Strategic Plans in countries where drug use constitutes a significant percent of new infections among young people. I know this is effective. As mentioned earlier, I study in Sydney, Australia. Sydney was an early adopter of needle exchange programs and the decriminalization of people who inject drugs. Research has shown it is the reason for low HIV and Hepatitis C rates amongst people who inject drugs. Personal experience has told me this is true. My hospital is located in an area of Sydney where there are high rates of injecting drug use, but our population of people living with HIV is low.
PACT members are also working to ensure knowledge is increased among policymakers and program developers about treatment gaps for young people living with HIV. One of our PACT members, Carlo from Puerto Rico, has lost several young friends in AIDS-related deaths in the past year. Why? They were suffering from treatment fatigue. Musah, our member from Uganda, works with other young people living with HIV in Busia, and they all want and need innovative technology and ideas for treatment aimed specifically at adolescents and young people. UNAIDS has done amazing work in ensuring a scale up of access to treatment, but we need to push even further – not only are adolescents not accessing treatment, but those who are accessing treatment need to have treatment that meets their unique needs as adolescents and young people.
The PACT also recognizes the impact of legal barriers on the ability of young people to access services. We want to see age-related laws and polices to enable access to services and not to serve as a barrier. We are taking actions to decriminalize sex work, drug use and sexuality. My friend Penny is a young GP in Thailand. Penny spoke to me about an adolescent girl that came to her because she wanted to know her HIV status, but because of the girl’s age she was unable to consent to an HIV test without the approval of her parents. Penny knew this girl’s evolving capacity indicated she was capable of consenting, but the laws tied Penny’s hands and prevented her from providing a needed service to her patient.
The action takers of The PACT know that we cannot do this work alone and that we need resources to achieve our aims. We believe that resources for young people and HIV should be allocated based on need and evidence, and that resources for young people must be allocated appropriately and existing decision-making mechanisms need to include the participation of young advocates Finally, The PACT feels strongly that HIV should be articulated as a priority within the post-2015 framework – as I noted above that over 188 community dialogues worldwide came to the same conclusion ending AIDS should be a priority in the post-2015 agenda, and we have committed ourselves to advocate at every level to see this happen.
I will leave you with a question, Young people have committed to take action and to hold themselves accountable for that action, how will member states hold themselves accountable?
