In 1996 the global HIV community gathered in Vancouver to share evidence that triple-combination antiretroviral treatment held the power to stem the tide of deaths from AIDS. The treatment era had begun. Today, as we gather again in Vancouver, we recognize a new transformative moment in the fight to end AIDS.
Building on knowledge accumulated over the last decade, the START trial has released its first results, showing that rather than waiting for immune deterioration, immediate antiretroviral (ARV) treatment more than doubles an individual’s prospects of staying healthy and surviving. Offering immediate ARV access is further supported by studies showing antiretrovirals can prevent transmission from people living with HIV to their negative partners. And data shows ARVs can effectively protect people at risk of infection through prophylactic use.
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 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.
This science accompanies achievement of a goal once widely considered unrealizable: 15 million people worldwide are receiving antiretroviral treatment and eight million deaths have been averted since 2000 by global activism, political will, and science. It is time to reach the 60 percent of people living with HIV who are not accessing treatment, including 19 million who do not yet know their status. We must ensure that the decision to use ARVs is an individual choice and that all people, regardless of social or legal status, race, gender or geography must have access to effective treatment and prevention. Knowing medicine cannot work in isolation and ARVs alone cannot end AIDS, a comprehensive, community-driven response attentive to underserved groups is urgent.
The world must act rapidly to drive down HIV incidence, death, and long term costs. Yet we are gravely concerned that the global AIDS response is under-resourced and that treatment rationing is too common. Only 10 countries have formally adopted the option for people diagnosed with HIV to start treatment immediately. Many have not fully implemented WHO guidelines to start at CD4 500, years after that recommendation. Further delays threaten not only millions of lives but threaten a resurgence of this pandemic.
We call on leaders the world over to implement HIV science and commit to providing access to immediate HIV treatment to all people living with HIV. We call on donors and governments to use existing resources for maximum impact and to mobilize sufficient resources globally to support ARV access for all, UN 90/90/90 goals for testing, treatment and adherence, and a comprehensive HIV response. We call on clinicians to build models of care that move beyond the clinic to reach all who want and need ARVs. We call on civil society to mobilize in support of immediate rights-based access to treatment for all.
Science has delivered solutions. The question for the world is: When will we put it into practice?
Initial Signatories (See the full list of signatories)
- Chris Beyrer, MD, MPH
President, International AIDS Society, Johns Hopkins University
- Deborah L Birx, MD
U.S. Presidents Emergency Plan for AIDS Relief
& Ambassador At Large/Special Representative for Global Health Diplomacy
- Julio SG Montaner, MD
Past-President, International AIDS Society, British Columbia Centre for Excellence in HIV/AIDS
- Michel Sidibe
- Mark Dybul, MD
The Global Fund to Fight AIDS, Tuberculosis & Malaria
- Françoise Barré-Sinoussi, PhD
Nobel Laureate, Institut Pasteur
- Peter Mugyenyi, MBChB, DCH, ScD
Joint Clinical Research Center, Makerere University
- Linda-Gail Bekker, MBChB, DTMH, DCH, FCP(SA), PhD
President-Elect, International AIDS Society, University of Cape Town
- Pedro Cahn, MD, PhD
- Helen Rees, OBE, MBBChir, MA, DRCOG
University of the Witwatersrand
- Jeffrey Sachs, PhD
Special Advisor to UN Secretary-General, Columbia University
- François Dabis, MD, PhD
University of Bordeaux
- Eric P. Goosby, MD
United Nations Secretary General Special Envoy for Tuberculosis
- Michel Kazatchkine, MD
UN Secretary General’s Special Envoy on HIV/AIDS in Eastern Europe and Central Asia
Graduate Institute of International and Development Studies
- Christine Katlama, MD
- Diane Havlir, MD
University of California, San Francisco
- Peter Reiss, MD, PhD
University of Amsterdam
- Elizabeth Anne Bukusi, MBChB, M.Med, MPH, PhD
Kenya Medical Research Institute
- Wafaa El- Sadr, MD, MPH
Columbia University International Center for AIDS Care and Treatment Programs
- Myron Cohen, MD
University of North Carolina at Chapel Hill
- James McIntyre, MBChB
University of the Witwatersrand