Another milestone passed in the AIDS era – 25 years since the virus was first discovered. That was last century, a quarter of a century ago. The most recent UNGASS has just ended. No mention of the word historic. Perhaps better forgotten. It seemed to have been characterized by acrimony, finger pointing and disputes. African AIDS activists were up in arms about some leaders wanting to dilute the messages they were giving, vis a vis homosexuality and gender. Others were irked at the luck of commitment to funding the fight against AIDS. The UN secretary general had unusually for him some harsh words on the progress that has been made in the fight against AIDS. And no wonder, what with all the same old arguments and debates being trotted out, to the background of global fund mismanagement, ABC disputes, data recounting or miscounting, lack of access to treatment …. It seems nothing has changed…

But much has changed in the last quarter of a century… the price of treatment has fallen 10 fold, scientific knowledge about the virus has advanced tremendously, funding has increased greatly…what is needed is the commitment and dedication that was brought to bear in the first decade of the fight against AIDS.. a renewal ceremony…oh yes that was what the UNGASS was supposed to be about. Oh well in another 5 years or 25….

And what of the future. At the moment it seems that we have we have arrived at an impasse in the fight against AIDS …people have run out of ideas, no one knows what to do next or how to take the fight forward. I have a radical solution; stop concentrating on HIV/AIDS as if it were the only health problem in world. The laser like focus on AIDS has led to a kind of tunnel vision, a seemingly myopic world, one in which if you are not somehow connected to AIDS, you are doing nothing for health in the developing world. This has led to the erosion and diversion of much needed resources, financial, material, manpower from other equally important health problems, and has probably led to a real decline in effectiveness of existing health programs.. True belatedly Tb and malaria were tacked onto the fight against AIDS but only as neglected orphans TB and malaria programs are still hugely underfunded in comparison to AIDS.

The fight against AIDS has had unexpected bonuses, if you can call them that. It brought about much needed attention to the lack of health workers, the high cost of treatment and drugs, unfair copyright and trade practices in health, the profound lack of infrastructure and woeful state of health systems in Africa to name not a few….

But the early successes in the first few years against the elusive HIV virus have not been repeated and are unlikely to be repeated…because if there is one other lesson that AIDS has shown, only a multi-pronged approach, a simultaneous systematic attack at all different levels is required. This is the basis of all successful public health endeavours. The current tactic where one method, for example prevention is abandoned in favour of something more in vogue such as ARV treatment has not had much success. What is needed is a back to basics approach and this in my opinion means reducing the emphasis on AIDS and increasing the efforts in tackling other health problems.