Health Policy$ense

“Science has delivered solutions. The question for the world is: When will we put it into practice?”

A transformative moment in fight to end AIDS

In the mid-eighties, I coordinated a medical genetics clinic at Johns Hopkins Hospital. We shared our outpatient unit, the Moore Clinic, with the AIDS Care Program, which began in 1984. Every week, I would see the devastating and shockingly rapid decline of robust young men—men my age—in the waiting room outside my office. I came to recognize the pattern:  two men would walk in, one weaker, one stronger.  At first, the weaker one needed only his caregiver’s arm for support.  As the weeks went by, the weaker man grew even weaker, and his caregiver pushed him—his friend, lover, or partner—in a wheelchair into the waiting room. The man with AIDS grew gaunt, then skeletal, with purple blotches on his face and vacant eyes. His caregiver looked tired and scared. And then that couple would be replaced by another two men, one stronger, one weaker, and sometimes I would recognize the weaker one as the previous caregiver. And on and on it would go, one young man helping the other across a threshold of death that he would soon cross himself.

I flashed back to those early years as I read a new piece in the Lancet on the success of antiretroviral drugs (ARVs) and its implications for health policy, co-authored by LDI Fellow Matthew Kavanagh and some of todays’ leading researchers in HIV.  In it, they describe the Vancouver Consensus Statement, signed by more than 500 researchers, clinicians, and others, that affirms that immediate access to ARVs holds the power to rapidly advance the fight to end AIDS. Delaying treatment or limiting it to immunocompromised patients can no longer be justified, scientifically or ethically. It states:

Medical evidence is clear: All people living with HIV must have access to antiretroviral treatment upon diagnosis. Barriers to access in law, policy, and bias must be confronted and dismantled. And as part of a combination prevention effort, PrEP [Pre-Exposure Prophylaxis] must be made available to protect those at high risk of acquiring HIV. The strategic use of ARVs – through treatment and other preventive uses – can save countless millions of lives and move us vastly closer to our goal of ending the epidemic. A new era of opportunity against this epidemic has dawned, and we must seize it.

In another article, Kavanagh and colleagues write about the advances of antiretroviral medicines and what they mean for human rights and concomitant health-related duties of States. In the US, we rarely use the language of human rights in current health policy discussions. Kavanagh’s article is notable for the depth of the discussion of these issues in the context of regulatory and resource limits:

A human rights perspective draws attention to failures of States—and perhaps even more so, international institutions—in eliminating this delay as a human rights issue. There is no reason why drugs should be distributed last to those most in need, except failure of the market to incentivize drug registration in poor countries. This is a problem that can be addressed, and is exactly the type of collective action challenge that WHO [World Health Organization] can and should address. In the US, HIV became a transformative issue and rights claims drove the creation of new models of drug regulation that are now used to speed access to a wide variety of medicines. A similar sea change is needed globally to create new mechanisms to drive early access to essential medicines and realize the highest attainable standard of health.

We stand before a far different threshold today than the one I witnessed in the 1980s. This threshold, on a global level, offers hope and health and life itself. Once again, we must help each other across it.