By Billie-Jean Nieuwenhuys, Policy Officer, International AIDS Society

The universal access pledge to provide HIV prevention, treatment, care and support to all those in need by 2010 was a key focus of the XVIII International AIDS Conference. There was wide scale agreement that although the commitment will not be achieved this year, the struggle to achieve universal access needs to continue. The conference provided the opportunity to take stock of the universal access pledge and devise strategies for taking the pledge forwards beyond 2010. As Dr. Michel Sidibe, Executive Director of UNAIDS points out, “it is not a time to scale down, but to scale up.”

The key debates on reaching universal access by 2015 appear to centre around two core issues: raising the overall resource demand from international donors as well as national governments and making more effective and efficient use of the resources available now. The Deputy President of South Africa Kgalema Motlanthe stated that “It is our duty and responsibility to use the platforms of the G8 and the G20 to advocate for more resources and that even as the world experiences an economic downturn, investments in HIV must not be the soft target for global austerity measures."

Participants and delegates throughout the week emphasised that the Global Fund to Fight AIDS, Tuberculosis and Malaria will be instrumental in helping to achieve universal access. A global financial commitment to replenishing the Global Fund with US$20 billion over the next three years will allow the Global Fund to scale up programming and bring us closer to the universal access goals. Global Fund Executive Director Michel Kazatchkine emphasised the need to increase donor support in line with the growing demand for healthcare to sustain the "considerable progress" in global health made over the last decade.

One of the key headline stories coming out of the AIDS 2010 are the results of the CAPRISA 004 study. Researchers demonstrated that the use of a vaginal gel/mircobicide containing the antiretroviral drug tenofovir resulted in a 39% reduction in HIV risk in women over a two and half year period. This news is a major success for women as the gel has the potential to give millions of women around the world the power to protect themselves from HIV infection. These preliminary results are extremely encouraging for both the HIV sector and the women’s sector, attention will certainly be focused on how these results are taken forward and whether the registration and release of the gel can be fast tracked and made available to women in the near future.

The conference emphasised the importance of a human rights–based approach to mitigating the extent and effects of the AIDS epidemic, and promoting universal access. Although there has been notable progress in many areas, punitive laws, policies, practices, stigma and discrimination continue to undermine the achievement of universal access targets including access to prevention for those who need it and the health related MDGs. Mark Heywood of Section 27 (formally AIDS Law Project) emphasised that the struggle for universal access is a broader struggle for social justice and giving a voice to the voiceless. He reminded us that activists have played a key role in turning the tide on AIDS and making it one of the most successful global public health interventions ever launched, and that activists will play a critical role in taking universal access beyond 2010. The conference emphasised the importance of framing the fight against AIDS within a broader human rights framework.

In addition, the conference increased anticipation and focus on prevention technologies in the momentum to reach universal access. Evidence has demonstrated that HAART is not only highly effective at preventing HIV-related morbidity and mortality, but it also dramatically decreases HIV transmission from all routes. This is now the recommended strategy to eliminate vertical transmission of HIV. The emphasis on being more efficient and doing more with the resources that are available resulted in UNAIDS launching Treatment 2.0, which calls for the radical simplification of treatment and its delivery to improve patient outcomes.

The AIDS 2010 provided a critical platform to assess progress in relation to achieving universal access. The importance of achieving universal access and bringing it in line with the other health MDGs has been emphasised. The Global Fund Replenishment meeting taking place in October will be the primary focus of the HIV sector in terms of advocacy and lobbying over the next couple of months. The conference demonstrated unequivocally that we know how to respond to this epidemic, we have the evidence and the strategies that need to be implemented. What is needed to make universal access a reality is the political will and the sector will continue to lobby to secure this.