Creating a world that survives, and thrives, with AIDS

The Ford Foundation officially launched its Global HIV Initiative during the 16th International AIDS Conference in Toronto. We launched the initiative because it was increasingly clear that, despite laudable advances in HIV technologies and outcomes, true ‘success’ was still evasive; continually being thwarted by age-old issues such as HIV-related stigma and discrimination, inequitable distribution of opportunities and advances, lack of accountability on the parts of financial, political and social leadership, and compromised outcomes as a result of unnecessary competition and redundancies. We believed that new paradigms were needed for understanding the pandemic and responding to its causes and effects. The Ford Foundation, with its rich history of advancing social change in support of marginalized and disenfranchised populations, was committed to lending its leadership support to the global response to HIV. As the HIV community from all walks of life now prepares to reconvene in Mexico City for the 17th International AIDS Conference, we are all given an opportunity to report on recent outcomes to stakeholders and constituencies worldwide. Ford strives, together with all who endorse the ‘universal access’ goal, for comprehensive options for HIV prevention, care, treatment and mitigation to be globally accessible by 2010. Mexico City provides a critical and final opportunity for us all to check in with each other before we come together next in 2010. With over 25 years having passed since AIDS was publically recognized, those who worked passionately to change how the world understands and responds to HIV/AIDS are now beginning to give way to a new generation of leaders. Whether scientists, clinicians, policy makers, advocates or activists, a whole new cadre of leaders is needed to take us to the goal of universal access in 2010 and beyond. These global leaders will reflect the demographics and dynamics of the HIV pandemic and will collaborate closely with local leaders who also come from communities impacted by the disease. It is imperative, therefore, that these new leaders be equipped with the knowledge gained over the past quarter century. We also need to ensure that they are prepared to utilize their own strengths, perspectives and voices in leading the way towards 2031, when the world reaches the 50-year mark since AIDS was first publicized. For many at the forefront of the HIV response of the first decade, it was the passion from self-survival, personal loss and collective anger that fuelled innovation and change. That, together with new passions about human rights, equities and accountability, may be necessary to impassion a new generation to pick up from where others have led. The challenges that confronted the world relative to HIV were, in the beginning, focussed upon the changes in sexual and injection-related behaviors most predominantly responsible for transferring HIV from one individual to another. Even now, as new communities face HIV vulnerability and risk, it remains essential that the most basic HIV prevention messages and technologies continue to be made available and improved. And yet, as more and more people who live with HIV are able to prolong productive life, the challenges that confront us become more complex. How, for example, do we ensure that healthy people on antiretroviral treatments made affordable through the Global Fund, the World Bank, the US President's Emergency Plan for AIDS Relief (PEPFAR) or other public resources, continue their treatments in the event that such resources diminish or disappear? Research presented at the recent (US) National Housing and HIV/AIDS Research Summit III documents the positive impact that housing has on improved health outcomes for HIV-positive individuals. Therefore, what must be done to ensure that HIV-positive individuals have access to affordable housing? How can we encourage innovation that leads to the discovery of much-needed new technologies and treatments that are affordable to those in greatest need? As environmental, economic and political events continue to instigate human migration across the globe, how might we ensure continuity of services and outreach? These, and many other second-generation HIV challenges, must become as central to the discourse as have condoms, clean syringes, abstinence and antiretroviral regimens. Central to all these challenges is the need for new leadership, strong commitment to equity, accountability to one another and partnership-based solidarity and action. The upcoming 17th International AIDS Conference in Mexico City provides the world with an opportunity to focus its attention on the current state of its response, and look towards its future. I trust the details that are found within this publication might help us all to begin to think about not only the latest in the art and science of HIV action, but also allow us to reflect upon the kind of world we hope to engender, with the values and actions that promote the efforts we know are necessary for reinforcing the human rights and dignities afforded to us all. Conflicts of interest: None.

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