Photo: President Clinton visits a health clinic in Lesotho in 2006.
Today is the 25th World AIDS Day – our pandemic is now old enough to have reached such a milestone. As I think back over the past 25 years, I will always remember the spring of 1996, when I was working as a clinician in Lesotho. It was the moment when we began to realize the terrible impact that HIV would have on our country. My patients were growing sicker by the day, and at times I thought there wouldn’t even be any more patients to care for within a few years. Walking through the streets of Mafeteng, I could begin to tell apart the ones who were sick and wouldn’t make it. We thought it was the end.
I had no idea if I could save my patients’ lives. But I had enough money for 200 HIV tests, and I decided to test every single patient that came to see me until the tests ran out. It took 3 days. When the results came back, I had to tell 80% of my patients that they were HIV positive. I promised myself then that I would put every last one on treatment.
The progress made since those early days in Lesotho – both here and around the world – is worth celebrating on this 25th World AIDS Day. This day is a time of hope for the HIV community. We have reached 8 million people globally with life-saving AIDS drugs. 10 countries have achieved universal access to treatment. We have the research and the science we need to end this epidemic.
And we’ve done it by working together. I’ve been proud and humbled to be a part of this community and its progress, through my work as a clinician and with the Government of Lesotho, the Global Fund, and the Clinton Health Access Initiative. In these roles I’ve seen firsthand the commitment and tireless work of people around the world – governments, NGOs, the medical community, the private sector, and so many more – collaborating to do the impossible, and to put an AIDS-free generation within our reach. But we must never forget the catastrophe of the early days, because in all of that hopelessness and uncertainty, we found incredible ambition.
All across Africa, we found the bravery that would make Zackie Achmat, a South African AIDS activist, stand up and promise that he would not take a single one of his pills until every last South African had access to treatment. We found the courage that allowed men and women to appear on TV and radio and publicly say, “I am HIV positive”, in the face of tremendous stigma and for no other reason than that others might face an easier path in the future. We found the endurance to make it through the countless, sleepless nights spent in Ministry offices that helped the world accomplish our 3x5 goals.
That ambition gives me hope. It still exists today – in Ministries and civil society and donor offices and in the communities where HIV has made its unwelcome home. And we need it more than ever, because another 7 million people need treatment and they need it right now. As I look to the future, we need to harness it in three ways.
First, we need to reinvigorate our commitments to ending AIDS at the highest levels – and developing countries can lead the way. We cannot mistake our tremendous progress for having this disease under control. Let me be clear – AIDS is still an emergency. In Lesotho and the other countries in Southern Africa, 1 in 4 people is living with HIV. AIDS still drains our resources, and orphans our children. We need presidents and ministers to publicly renew their commitment to ending this disease – as the United States Government did this week- and to commit the resources that we need to finish the job.
Second, we need to have the courage to spend our money more wisely. To end AIDS, we will need to move mountains – treatment for all, the elimination of mother-to-child-transmission, and a higher standard of care for patients. This is going to cost money, and there’s only so much to go around. Governments need to ask themselves whether they are spending their money on the highest impact interventions – and if not, to make the hard choice to change course, and cut programs that aren’t working. We also can and should transition more responsibility to governments and communities of developing countries. Local leadership will decrease costs and free up funding for the drugs and other interventions that will save patients’ lives.
Third, we need to constantly challenge ourselves to set the visionary goals that will get us to zero. With 8 million people on treatment, the HIV apparatus – hospitals and clinics and mobile centers, donor groups and partner interests – is enormous, and sometimes unwieldy. Too often, I see people getting accustomed to doing things in a certain way, and becoming resistant to taking on the big challenges that can put us on a path to end AIDS. We will never end AIDS without setting the kinds of goals that people like to say are impossible to achieve – until we achieve them. It’s time to scale up our ambitions – not incrementally, but exponentially.
In 2005, a few weeks before President Clinton and Bill Gates visited Lesotho to open the first dedicated pediatric HIV clinic in the country, I followed up with my very first cohort of patients from 1996. With the help of the Elton John AIDS Foundation, I had kept my promise – my patients were all still on treatment and not a single patient had died of AIDS.
When the end of AIDS seems far away and the path ahead feels overwhelming, I think back to the miracle of those men and women coming back to life, and I have no doubt that our ambition will carry us to a better future.