Expert insight

40 years of progress: A necessary but incomplete milestone

1 December 2021
  • Greg Perry Assistant Director General

This World AIDS Day, we mark 40 years since the first HIV case was identified. While there is much to reflect on, the most important takeaway is that there is still further to go to prevent new infections and treat the millions of people living with HIV/AIDS today.

HIV has been a disease with tragic consequences on too many lives and livelihoods around the world – over 36.3 million people have died since the beginning of the epidemic, hitting certain parts of the world, like Africa, hardest. But it is also a story of progress and innovation within the industry. When HIV was first identified, there was no cure and HIV was a death sentence. In the decades since, it’s become the chronic, manageable illness that it is for many today.

This is due in no small part to a healthy innovation ecosystem. Since the start of the HIV epidemic, the FDA has approved over 40 medications and medication combinations to treat HIV. There are more than 50 medicines and vaccines for HIV treatment and prevention in development, including pediatric care, and new horizons for HIV care emerging from science and innovation during the COVID-19 pandemic. For instance, mRNA technology could significantly accelerate the pace of HIV vaccine development.

But, while innovation has been instrumental in transforming the lives of many living with HIV/AIDS, industry’s response in the early decades of treating HIV/AIDS was rightly criticized. Pharmaceutical companies have evolved and learned from previous setbacks and mistakes to ensure access to their innovation wherever people lived.

It opened the gates to create some of today’s most important public private partnerships to tackle health inequalities, most notably The Global Fund to Fight HIV/AIDS, Malaria and Tuberculosis. It also led the way to create the Medicines Patent Pool and marked a turning point in growing generic manufacturing expertise and capacity – in India, but also in Africa.

Despite this, the advances of HIV/AIDS innovation are not reaching all people. Delivery and management of HIV treatment and prevention remains a key global health challenge and a health equity issue. We’ve fallen behind on these targets for certain people in certain places who are unable to access the care they need and deserve. COVID-19 has especially disrupted HIV/AIDS testing and management of the disease – HIV testing alone has fallen 41 percent according to data collected from 32 countries in Africa and Asia.

The work is not done to ensure equitable access to treatment and care

More than 37 million people are still living with HIV. Today, the causes for people not getting access to treatment are manifold and complex, both in rich and poor countries. There is still social, cultural, and religions stigma for marginalized and vulnerable populations, including men who have sex with men, people who inject drugs, prisoners, migrants, homeless populations, women, adolescent boys and girls, and children.

What’s important to highlight is that the conversation is no longer singularly focused on treatment. HIV/AIDS was one of the first global crises of our times where governments, businesses, multilateral organizations, and NGOs worked together to create a safe, accessible, and affordable environment for people to seek testing, treatment, and care. It is and should be a template for understanding how to respond to the COVID-19 pandemic.

Community engagement has been a critical factor to enable and catalyze progress across both health and social systems for HIV/AIDS care. We must leverage community-led initiatives to respond to the needs of the most vulnerable people in an equitable and sustainable manner. All stakeholders, including the biopharmaceutical industry, must focus on our joint commitment to HIV/AIDS and take what we’ve learned from the COVID-19 pandemic to benefit from and join for speed in innovation.

Now is not the time to sit on our laurels. We must ask, what will be our legacy at the 50th anniversary? There is still a distance to go in closing the gap in care between children and adults living with HIV and we need proactive collaboration to ensure children aren’t left behind, as illustrated by the Pediatric HIV & TB Rome Action Plan. In Africa and worldwide, women and adolescent girls remain especially vulnerable, accounting for more than 60 percent of new infections in Sub-Saharan Africa. Six in seven new HIV infections among adolescents aged 15– 19 years are among girls.

IFPMA remains an involved stakeholder and advocate in ensuring that all people everywhere have access to the HIV treatment, care, and social support they need. As we mark this important milestone of 40 years since the first HIV case, we must keep our eyes on the day when we will mark the last. Until then, our work is not done.

Greg Perry provided a version of these remarks in a news-style program about HIV at 40 produced by British HIV Association, Terrence Higgins Trust, Elton John AIDS Foundation and ITN Productions, launched on World AIDS Day. Watch it here.