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?