The Issue

Just recently, 16,000 gathered in Amsterdam for the International AIDS Conference—“AIDS2018.” Many leading figures painted a sobering picture: goals for global HIV/AIDS treatment and prevention goals are not likely to be attained, funding has declined, high-level political will is lacking, and there is the risk of a resurgent epidemic. All of which makes for considerable discomfort and uncertainty. We are at a turning point in thinking about what comes next in controlling HIV/AIDS in the coming years.

During the week of July 23, 16,000 advocates, persons living with HIV, scientists, clinicians, service providers, policymakers, and researchers convened in Amsterdam for the biannual International AIDS Conference—“AIDS2018.”

Collectively, a large number of the leading figures at Amsterdam painted a common, deeply sobering picture. In varying ways, each acknowledged that global HIV treatment and prevention goals are not likely to be attained, while there is little evidence or hope of major new funding to meet outstanding needs in the global response (indeed, the likelier prospect is continued decline). That is matched by a conspicuous deficit of high-level political will, and intensified competition for attention and resources. Several voiced the fear of losing ground, and several pointed to the real risk of a resurgent epidemic.

This is the new prevailing consensus, the new realism. It is what you heard in listening in Amsterdam to the individual public remarks of Michel Sidibé,1 head of UNAIDS, Peter Sands,2 head of the Global Fund to Fight AIDS, Tuberculosis and Malaria, Peter Piot,3 former head of UNAIDS and now Dean of the London School of Hygiene and Tropical Medicine, and Mark Dybul,4 former head of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund and now at Georgetown University.

It is what you read in the writings of Jon Cohen of Science,5 Chris Beyrer and Linda-Gail Bekker et al. in the International AIDS Society (IAS)-Lancet Commission report,6 Richard Horton and Pamela Das of The Lancet,7 Laurie Garrett in Foreign Policy,8 and a reporter in The Economist.9

Interestingly, this pronounced shift in tone and substance does not jettison pride and optimism. Rather, what you often encounter is an awkward back and forth between hope and pessimism. The result: HIV/AIDS has come to occupy an uncomfortable, unstable, and murky middle ground. It is a place of decidedly mixed sentiment, that frankly can be confusing and fragile, that feeds fear and uncertainty, and that begs for answers that remain elusive.

The Dilemma

Today the AIDS world faces a confounding dilemma.

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Written by: J. Stephen Morrison, Senior Vice President and Director, Global Health Policy Center,