20 July 2012
Around 30 years ago, young and previously healthy men started dying of an unknown disease in the US. What followed – the global spread of a lethal virus that attacks the immune system, an epidemic concentrated in the most vulnerable and marginalized populations and the mobilisation of an extraordinary advocacy movement – changed public health forever. As the global health community gears up for the 19th International AIDS Conference in Washington DC next week, I am reflecting on what HIV/AIDS means for diabetes.
The global HIV/AIDS response – the largest vertical disease programme in history – has achieved huge reductions in infection, suffering and death, with many people with HIV now surviving into old age. I heard the singer Elton John this week on BBC radio say ‘These days HIV/AIDS is easier to treat than diabetes’. How the world has changed! It is truly a phenomenal achievement that today people are living with HIV/AIDS rather than dying from it. But the sad truth is that with people with HIV/AIDS, despite living longer, are now at a greater risk of developing NCDs such as cancer and diabetes, which are often linked to the HIV infection and the medicines used to treat it.
In diabetes, we have learnt a great deal from HIV/AIDS. The 2001 United Nations General Assembly Special Session on AIDS was the inspiration for the 2011 UN Summit on NCDs which has proved a turning point for NCDs. Second, it was quickly apparent that the response needed to tackle the deadly HIV epidemic went far beyond the health sector, requiring a whole-of-society approach. We urgently need the full mobilisation of society to combat diabetes/NCDs, based on multi-sectoral ‘Triple P’ Partnerships uniting public, private and people.
Third, we can leverage the treatment and care regimen for HIV/AIDS, as our needs – from education on prevention and management, to diagnosis, long term care, self-management and monitoring – are remarkably similar and also focused on the primary-care level. But on the ground, we continue to see the health sector organized by siloes and dominated by a disease-specific approach. In many parts of the world, there are state-of-the-art health facilities where people receive comprehensive treatment for HIV, while people with diabetes go undiagnosed, untreated and can be bankrupt by the costs of care. In a global economic crisis, we need to use our resources to drive well-functioning and equitable health systems that treat the whole person, whatever their disease. I do see positive signs that the era of siloed programmes is passing; the recent UN report on the place of health in the post-2015 development agenda recognises that vertical disease-specific approaches are no longer adequate.
But the greatest lesson we can learn is from people living with HIV/AIDS themselves. Radicalised by fear and outraged by discrimination, these people turned the disease into a human rights issue, had remarkable success in advocacy, and fundamentally changed the concept of a patient from a passive recipient of medical care to someone actively involved in their treatment and care. The voice of people living with HIV/AIDS is still loud, and has to be – AIDS still causes 2 million deaths every year and 2011 saw the first ever decline in HIV funding.
As people unite in DC next week to combat these issues, their activism and sense of outrage continues to inspire me and poses a question to the global diabetes community. A person dies from diabetes every seven seconds. Where is our outrage?