HIV and AIDS in 2030

A Choice Between Two Futures

David R. Barstow

• Publisher: GOYTS Publishing
• Year: 2019
• ISBN:
  9781733142410
• Topic: Medicine
• Subtopic: AIDS & HIV

Two Futures—Millions of Lives

2030 will be a year of reckoning for the AIDS epidemic, marking fifty years of one of the worst epidemics in the history of the world. The 28th International AIDS Conference will be held in July of that year in Durban, South Africa. The conference will include a panel of leaders looking back on the fifty-year history of HIV and AIDS. But what will the panelists say?

If HIV and AIDS have made a strong resurgence in the 2020s, the panel will be called How We Lost the War Against AIDS, and the panelists will focus on the mistakes that led to an overwhelming human catastrophe.

But in a different future, a future in which HIV and AIDS are no longer threats to public health, the panel will be called How We Won the War Against AIDS, and the panelists will celebrate the wise decisions that led to a humanitarian triumph.

Which future will we see? Now is the time to choose.

David Barstow deftly combines the meticulous attention to order and detail that you would expect from a scientist with the persistence and passion for action you would expect from an activist.

—From the foreword by Dr. Jonathan Quick, MD, MPH, author of The End of Epidemics: The Looming Threat to Humanity and How to Stop It

David Barstow’s book lays out two possible storylines based on the two possible choices the world might make: a scenario of terrible human suffering or a victorious ending where humanity “wins” and the threat is averted. We can write this next chapter, but what will we write? The choice is ours to make.

—Richard Stearns, President Emeritus, World Vision US

Barstow paints a picture of what the future will look like if we do not urgently recognize that we are far from ending AIDS. He shows that Two Futures are possible. The HIV response has been one of the most successful in the history of public health. If we act now, we can get to the end. If we do not, history will not treat current policy makers well.
—Mark Dybul, Professor and Co-Director, Center for Global Health and Quality, Georgetown University Medical Center

How We WON the War Against AIDS

Transcript of a Plenary Session
28th International AIDS Conference
Durban, South Africa
29 July 2030

Note from the Editor

There was an unusually large amount of media coverage of the 2030 International AIDS Conference, recently held in Durban, South Africa. Much of the media coverage was related to one specific panel session and the massive demonstrations that occurred outside the conference center while the panel was being held. Given this heightened interest, members of the Program Committee of the IAC have decided to make publicly available a complete transcript of the panel session. The transcript has been compiled from video recordings of the panel session. The words are those spoken by the panelists and audience members, except for minor edits to improve the flow.

David R. Barstow, Editor

5 August 2030

Corvallis, Oregon, USA

Question from the Audience

You’re sitting up on a stage with a big sign that says, “HOW WE WON THE WAR AGAINST AIDS.” How does that make you feel?

Mr. De Jong

For me, it’s joy, of course, but also sadness. I’m sure we could have won the war quicker and better, and then some of the people who died might still be here with us.

Amb. Rogers

I remember back in the late 2010s, we could so easily have given up, or even just slowed down. And then we’d be here on a stage with a sign that says, “HOW WE LOST THE WAR AGAINST AIDS.” I can’t imagine how depressing that would have been.

Dr. Nkosi

I keep thinking about the millions of people whose lives were saved. Every one of those people is a living, breathing, human being, with family and friends and hopes and dreams. They are the ones whose feelings really matter.

Imam Karume

I know that pride is a dangerous sin, but in all honesty, I have to admit to feeling a little pride that we religious folk were so instrumental in coping with the social issues.

Introduction

Dr. González

Could you all please find seats so we can get started. I know there was a lot of commotion and confusion outside the hall, and that has delayed the start of the session. You can all help us get going if you take your seats.

While you are taking your seats, I’d like to update you on the demonstrations that took place throughout Durban today. We believe they are the largest demonstrations in the history of the AIDS epidemic. The police have estimated that over 50,000 people participated. I know that we all have seen demonstrations at previous AIDS conferences. This is perhaps the first time that the demonstrations have had such a celebratory tone.

For we do indeed have something to celebrate. As indicated by the title of the panel, How We Won the War Against AIDS, we are celebrating success in one of the greatest humanitarian initiatives in history.

[Editor’s note: At this point, there was prolonged applause, lasting several minutes.]

It’s amazing to be able to celebrate like this!

OK, it looks like things have settled down in the auditorium. Let’s get started.

My name is Dr. Rafael González. It has been an honor to serve as the President of the International AIDS Society for the past two years. In that position, I am one of the Co-Chairs of this conference, the 28th International AIDS Conference.

This is now the third time that the International AIDS Conference has been held in Durban. Each time has marked a significant turning point in the AIDS epidemic.

The 13th IAC was held here in July 2000. It was the first time that the AIDS conference had been held in Africa and marked the global recognition of the magnitude of the AIDS epidemic.

Sixteen years later, the 21st IAC was held here in July 2016. It marked the first time that we believed we might actually be able to end AIDS. We had achieved remarkable progress, really amazing progress, in getting people with HIV on ARV treatment. And there was a strong sense that we had it in our power to end AIDS as a public health threat by 2030.

Now it is 2030, and we are here in Durban to mark our success. We have used the power we had, and we can now say that we have eliminated HIV and AIDS as public health threats.

[Editor’s note: The audience broke into spontaneous applause that lasted several minutes.]

Now, in the final session of this conference, we have assembled a special panel, partly to help us celebrate our success, our victory over AIDS, and partly to look back to find lessons that will be helpful when we face future epidemics. How did we win the war against AIDS?

The panel will be moderated by Dr. Zhang Xiu Ying, the Director-General of the World Health Organization. Dr. Zhang, could you please introduce the other panelists and start the discussion.

Dr. Zhang

Thank you, Dr. González.

So the question is: how did we win the war against AIDS? We have invited eight panelists with distinguished backgrounds to help us answer this question. On the stage here with me, from your left to your right, we have:

Imam Ahmed Karume, the Executive Director of INERELA+, the International Network of Religious Leaders Living with or Personally Affected by HIV or AIDS.

Dr. Munashe Nkosi, the Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Mr. Joost De Jong, the Executive Director of WHN, the Worldwide HIV Network, an advocacy group for people living with HIV.

Rev. Emily Morgan, the Executive Director of Christian Health Alliance, a consortium of Christian NGOs.

Dr. Chibuzo Okafor, the Director of African Projects for International Interfaith Relief Services, a coalition of relief service organizations from a variety of religious traditions.

Dr. Olivia Bennett, on the faculty of Yale University in the School of Public Health. She was the President and Chief Executive Officer of the Campaign to End AIDS in America from 2024 through the closing of the organization in 2027.

Dr. Jaylen Thomas, the Director of the Centers for Disease Control and Prevention in the United States.

Amb. Christopher Rogers, who served as the United States Global AIDS Coordinator from 2023 to 2028. He ran PEPFAR during the last five years of its existence.

You can find more information about our panelists in your printed program.

I should add that the panelists today will be speaking as individuals, not as representatives of the organizations they work for. Opinions they express do not necessarily represent official positions of their organizations.

You may notice that the panelists are primarily public health experts, AIDS activists, and religious leaders. We have several scientists and doctors, but their careers have not focused on research or providing medical services directly to patients. That was a deliberate choice when we planned this panel. We won’t be discussing the science of HIV and AIDS. That’s not to undervalue the remarkable scientific and medical achievements. Without them, there would have been no hope of winning. But the hardest part of winning the war against AIDS has been the difficulty of using the knowledge effectively.

I will start this session by reviewing the basic epidemiological data from the fifty-year history of the AIDS epidemic. Then we will have open discussion among the panelists about three specific topics: funding, social drivers, and religion. In order to stimulate a livelier discussion, I have asked the panelists not to discuss the topics amongst themselves prior to their appearance on this panel. Of course, knowing the panelists as I do, it seems quite likely that they ignored my request!

Following the discussions about the three topics, we will open the panel to questions from the floor. We hope to have about twenty minutes for questions. We will then have brief closing statements by the panelists.

Let’s get started.

Fifty Years of the AIDS Epidemic

Dr. Zhang

You have all seen this chart [Figure 1, below] before. It shows the annual rates of new HIV infections and AIDS-related deaths in the fifty years since the epidemic began in 1980. This is worldwide.

To quickly review the data, there was a rapid increase of new infections during the first fifteen years, peaking at 3.4 million in 1995, after which the rate of new infections began to decline. The decline has been pretty steady, except for a few years at the end of the 2010s. We project that the number of new infections in 2030 will be about 260,000 and will continue to decline in the foreseeable future.

Figure 1—Fifty Years of the AIDS Epidemic

The annual number of deaths from AIDS-related causes rose rapidly through the mid 2000s, at which point it also began to decline. Progress in reducing deaths has been pretty steady since its peak, with the exception of the same few years at the end of the 2010s. We project that there will be about 340,000 AIDS-related deaths in 2030. These also will continue to decline in future years.

During the fifty years of the epidemic, a total of about forty-four million people have died. Several years ago, we were worried that the number of deaths might ultimately go above sixty or seventy million, which would have been more than the number of people who died during World War II, the deadliest military war that the world has ever experienced. Fortunately, we were short of that, although still ahead of the death count for every other military war. So the war against AIDS still qualifies as one of the deadliest wars in human history.

Now, in looking at this chart, there are several time periods of particular interest. Certainly, the most important is right now, where we can see that we have brought HIV and AIDS under control. That’s why we can have this panel with such a remarkable title, How We Won the War Against AIDS!

[Editor’s note: The audience broke into spontaneous applause that lasted several minutes.]

But looking backward, we can also see the two peaks, the peak for new HIV infections in the mid 1990s and the peak of AIDS-related deaths in the mid 2000s. The first was when intensive prevention programs in sub-Saharan Africa began to have an effect. The second was when ARV treatment programs becam...