An international coalition of scientists and activists launches a common platform for ending the AIDS epidemic. Thirty years into the epidemic, as world leaders come together at the United Nations to recommit to a global AIDS response, the broad-based international coalition issued a statement calling for world leaders to support a rational, evidence-based approach to responding to AIDS. The group also calls for additional signatories to the declaration.

"As at so many other critical points in the epidemic, we have the opportunity now to use the fruits of science and research to show the way forward. Putting more people on AIDS treatment will save lives and prevent new infections, and will also help build and strengthen platforms for delivering comprehensive health services in resource-poor settings," said Paul Farmer, Harvard University Professor and co-founder of Partners In Health. "We have the knowledge and the tools to reverse the epidemic - and we must not fail to use them."

The declaration, "We Can End the AIDS Epidemic," argues that highly-active antiretroviral treatment (ART) for HIV positive people is a preventive strategy that is a cornerstone to ending the epidemic.

The founding group of signatories includes African Services Committee, AIDS Foundation of Chicago, AIDS United, amfAR, AVAC, ATHENA Network, Black AIDS Institute, Canadian HIV/AIDS Legal Network, Fenway Health/The Fenway Institute, GIV, Health GAP, HIV Prevention Justice Alliance, International Community of Women Living with HIV, International Rectal Microbicide Advocates, International Treatment Preparedness Coalition, New HIV Vaccine and Microbicide Advocacy Society, Open Society Public Health Program, Partners In Health, Project Inform, Treatment Action Campaign, Treatment Action Group, and the Wits Institute for Reproductive Health and HIV, and more than two dozen leading global AIDS researchers and advocates.

"This statement represents the common vision of scientists and activists to halt the epidemic. For the first time in three decades, we now have the real potential to end the AIDS epidemic. The question now is will we?" said Mitchell Warren, AVAC executive director. "Recent breakthroughs in AIDS vaccine, PrEP and microbicide research suggest powerful, additional tools for the future. Right now, the scientific evidence that treatment is prevention must serve as a clarion call to funders, policy makers and program implementers to move forward boldly and quickly to capitalize on the conclusive evidence provided by the clinical trial HPTN 052."

HPTN 052 found that earlier initiation of antiretroviral treatment provides a health benefit to HIV-positive people, and is a highly powerful tool for preventing transmission to sexual partners.

The statement calls for:

World leaders to adopt ambitious treatment and prevention targets.
Donors, including PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria, to evaluate existing and new funds with core activities including antiretroviral treatment for individuals with CD4 cell counts at 350 or above
All working on the AIDS response to end non-integrated, artificially-separated approaches to funding and delivering treatment and prevention services.
Donors, communities, implementers, industry and researchers to map and execute an implementation research agenda for ART as part of combination prevention strategies.
"The most expensive, least effective strategy is to continue spending on AIDS the way that we are today," said Nono Eland of South Africa's Treatment Action Campaign. "We need more resources and better strategy. Funds need to be aligned with what is known to work-and reprogrammed where needed. We have no time to waste. World leaders at the UN this week should make clear commitments to the platform outlined in this statement."

According to the declaration, and consistent with a new investment framework from UNAIDS published last week in the Lancet, funding needs to be directed to evidence-based strategies with combination ART as a cornerstone of a set of proven strategies to prevent and treat HIV, including male and female condoms, male circumcision, prevention of vertical transmission, behavior change programs that target social norms as well as individual risk, and activities addressing key populations including sex workers, men who have sex with men and harm reduction programs for injecting drug users. Funds that are not aligned with these core activities need to be justified and, where applicable, reprogrammed.

"The scientific evidence is clear. We know that early treatment has health benefits for HIV-positive people, and we now know that treatment also provides clear benefit for prevention," said Kenneth H. Mayer, M.D. of Fenway Health. "As we work to scale up HIV treatment programs, we must also scale up and sustain research that builds on important proof of concept for biomedical prevention options, including pre-exposure prophylaxis, or PrEP, microbicides and vaccines to prevent HIV. Widespread treatment access coupled with new prevention options will be essential as we move to end this epidemic."

The declaration grew out of a think tank on optimizing the potential of ARV-based prevention convened by AVAC with support from the John M. Lloyd Foundation. The meeting brought together 25 HIV experts to discuss the way forward capitalizing on mounting evidence of the broad benefit of widespread access to antiretroviral treatment.

The full text of the declaration, along with a list of signers, is available at www.avac.org/endtheepidemic, where additional individuals and organizations can also sign on.

About AVAC: Founded in 1995, AVAC is a non-profit organization that uses education, policy analysis, advocacy and a network of global collaborations to accelerate the ethical development and global delivery of AIDS vaccines, male circumcision, microbicides, PrEP and other emerging HIV prevention options as part of a comprehensive response to the pandemic.