Lessons from the global HIV response

By Marielle Hart

Marielle Hart is Lead: Policy at the Alliance.

The global response to HIV of the past decades has provided valuable lessons for other movements working for better health of people.

We have learned that a comprehensive package of HIV services, including prevention, treatment, care and support, is required to save lives. These services will not be successful when offered in isolation: they are inextricably linked. For example, early initiation of and adherence to treatment of people tested positive for HIV is an effective means of preventing further transmission, and providing ongoing care and support to people on treatment improves treatment adherence.

<p>Dao Korotoum, 19 years, entering a mobile clinic in C&ocirc;te d'Ivoire.&nbsp;&copy; Nell Freeman for Alliance&nbsp;</p>

Dao Korotoum, 19 years, entering a mobile clinic in Côte d'Ivoire. © Nell Freeman for Alliance. 

We have also learned that HIV cannot be eradicated without getting serious about human rights. HIV-related stigma and discrimination, and marginalization and criminalisation of key populations –including men who have sex with men, people who use drugs, sex workers and transgender people – pose major barriers for ensuring equitable access to HIV and health services as it drives people underground and increases their risk of HIV infection. Removing discriminatory laws and ensuring that the human rights of people living with and affected by HIV are protected is critical for a successful HIV response and for achieving good health outcomes.

We have learned that HIV cannot be eradicated without getting serious about human rights

Finally, the active engagement of communities has been a driving force in achieving successes in combating HIV. Networks of people living with HIV, key populations and other affected communities, and community-based organizations have played a fundamental role in providing services to the most marginalized and stigmatized. They provide testing and care, link people to treatment and other services, advocate for a rights-based and inclusive response, and hold governments accountable for their commitments.

These lessons should be taken on-board by the movement for universal health coverage (UHC), a global health agenda driven by the World Health Organisation, the World Bank and an increasing number of national governments. The UHC movement aims to ensure that everyone has access to the health services they need and that these services are of sufficient quality to be effective, while protecting people against unaffordable out-of-pocket spending. 

The active engagement of communities has been a driving force in achieving successes in combating HIV

Achieving UHC will be no easy task. Health financing reforms will need to be accompanied with addressing discrimination, poor quality of care, low capacity and other barriers to accessing services. The current approach to UHC is too narrowly focused on the public health system and treatment, while giving inadequate attention to disease prevention and community-delivered health care, and does not sufficiently address human rights related barriers to accessing health services.  This is where the lessons from the global HIV response have a lot to contribute.

In Building from the HIV Response toward Universal Health Coverage we outline how the agenda for UHC can usefully build on the innovative approaches of the HIV response in areas of governance, financing, service delivery, political mobilization, accountability and human rights. The UHC and HIV movements can provide a model for coordinated action in the next era of global health.