title: Redesigning the AIDS response for long-term impact.
abstract: Three decades since the human immunodeficiency virus (HIV) was identified, the pandemic of acquired immunodeficiency syndrome (AIDS) has developed into diverse epidemics around the world. In many populations, HIV infection has become endemic. While there is good progress on expanding access to treatment, with an estimated 6.6 million people on antiretroviral therapy at the end of 2010, prevention efforts are still highly inadequate with 2.6 million new infections occurring in 2009. Demand for treatment is increasing while funding is becoming more scarce and activism is waning. In 2007, the Joint United Nations Programme on HIV/AIDS (UNAIDS) established an independent forum called aids2031 to take a critical look at the global HIV/AIDS response. This paper outlines four key areas for a re-designed AIDS response based on the deliberations of this initiative and on the learning and experience of the first three decades of the epidemic: (i) a new culture of knowledge generation and utilization; (ii) transformed prevention and treatment to increase effectiveness; (iii) increased efficiency through better management and maximizing synergies with other programmes; and (iv) investment for the long term. Across all these areas is a strong emphasis on local capacity building, leadership, programme priorities and budgets.
authors.affiliation: London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, England. Heidi.Larson@lshtm.ac.uk
authors.forename: Heidi J
authors.initials: HJ
authors.lastname: Larson
authors.forename: Stefano
authors.initials: S
authors.lastname: Bertozzi
authors.forename: Peter
authors.initials: P
authors.lastname: Piot
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000453:epidemiology; D017954:Africa South of the Sahara; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003657:Decision Making; D004196:Disease Outbreaks / Q000517:prevention & control* / Q000706:statistics & numerical data; D014943:Global Health; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy / Q000639:trends*; D006293:Health Promotion / Q000379:methods; D006801:Humans; D016730:Program Development / Q000379:methods; D011634:Public Health; D040241:Social Marketing; D013997:Time Factors
chemical_list: D019380:Anti-HIV Agents
references.citation: Am J Public Health. 2007 Nov;97(11):1934-6
references.pmid: 17901417
references.citation: Health Aff (Millwood). 2009 Nov-Dec;28(6):1578-90
references.pmid: 19887400
references.citation: Lancet. 2011 Jun 11;377(9782):2031-41
references.pmid: 21641026
references.citation: Lancet. 2009 Dec 19;374(9707):2080-2089
references.pmid: 19939445
references.citation: Health Aff (Millwood). 2009 Nov-Dec;28(6):1617-28
references.pmid: 19887403
references.citation: Lancet. 2010 Jan 9;375(9709):123-31
references.pmid: 20004464
references.citation: Lancet. 2008 Sep 6;372(9641):845-59
references.pmid: 18687458
references.citation: MMWR Morb Mortal Wkly Rep. 1981 Jun 5;30(21):250-2
references.pmid: 6265753
references.citation: Nature. 2010 Mar 11;464(7286):224-31
references.pmid: 20220841
references.citation: Glob Public Health. 2011;6 Suppl 3:S293-309
references.pmid: 21745027
references.citation: Lancet. 2011 Jul 16;378(9787):269-78
references.pmid: 21763938
references.citation: Nature. 2010 Mar 11;464(7286):161-2
references.pmid: 20220821
references.citation: N Engl J Med. 2010 Dec 30;363(27):2587-99
references.pmid: 21091279
references.citation: Lancet. 2011 Jun 18;377(9783):2055
references.pmid: 21684364
references.citation: Lancet. 2008 Jun 21;371(9630):2064-5
references.pmid: 18572064
references.citation: Lancet. 2006 Aug 5;368(9534):526-30
references.pmid: 16890840
references.citation: Sex Transm Infect. 2010 Feb;86 Suppl 1:i76-82
references.pmid: 20167737
references.citation: Lancet. 2010 May 8;375(9726):1609-23
references.pmid: 20382417
references.citation: J R Soc Med. 2008 Dec;101(12):572-3
references.pmid: 19092021
references.citation: N Engl J Med. 2006 Jun 8;354(23):2414-7
references.pmid: 16760441
references.citation: N Engl J Med. 2011 Aug 11;365(6):493-505
references.pmid: 21767103
references.citation: BMC Health Serv Res. 2009 Jan 09;9:5
references.pmid: 19134202
references.citation: Lancet. 2009 Dec 19;374(9707):2035-2038
references.pmid: 19942274
references.citation: Science. 2010 Sep 3;329(5996):1168-74
references.pmid: 20643915
references.citation: Lancet. 2011 Apr 23;377(9775):1438-47
references.pmid: 21474174
references.citation: Math Biosci. 2010 Oct;227(2):94-104
references.pmid: 20600157