The similarities facing China, India, South Africa, and Brazil don’t necessarily jump off the page. However, important commonalities exist that the global health community needs to examine — and perhaps model in low income countries.
China, India, South Africa, and Brazil are emerging world powers that have made important advancements in changing the course of the HIV & AIDS epidemic in their countries.
At a special session of the XIX International AIDS Conference on Tuesday, July 24, hosted by Stephen Morrison of the Center for Strategic and International Studies and anchored by renowned economist, Jeffrey Sachs, high level speakers from each of these countries reflected on significant activities that changed their country’s course in HIV & AIDS management. The leaders also discussed how their countries can help lead the way in the fight against the epidemic.
Three themes developed from the conversation of how these countries were able to successfully manage the epidemic in their countries: (1) A country must invest in health not as the end goal, but as a critical instrument of economic development. (2) Reducing the cost of antiretrovirals (ARVs) is critical to get more people on treatment quickly (each country had a different approach). (3) A strong, educated leadership makes the difference. It is the Ministry of Health and global health professionals job to educate government leaders on health.
The South African Health Minister, Dr Pakishe Aaron Motsoaledi, said the focus on HIV & AIDS is what made the difference for his country. The government worked with partners to dramatically reduce the cost of ARVs by 53% which helped get 1.7M people on treatment. “2009 was our turning point,” he said. “There was a real commitment made by the Government at all levels to improve health impact.”
In China, over 80% of the AIDS budget is from the Chinese government directly, explained Dr Wu Zunyou, director of the National Center for AIDS/STD Control and Prevention, Chinese Centre for Disease Control and Prevention. The trigger point was the SARS outbreak: leadership made rapid changes to control the outbreak and their mindset changed to focus on respecting health as a human right and protecting marginalized groups.
Dr Dirceu Greco, who has served as a member of the Brazilian Ministry of Health’s National Commission on AIDS, explains that Brazil set standards early, owned 100% of the response, and most importantly has developed the world’s largest public health system with over 100 million people in the system. Brazil invested in health, not just HIV and that was crucial to curbing the disease in Brazil.
India dramatically scaled up their HIV program to manage the HIV epidemic. From the beginning, they stuck to a scientific, evidence-based approach when addressing the concentrated epidemic in India. Aradhana Johri of India’s National AIDS Control Organisation, said that the key was to never lose the focus on prevention efforts.
As middle income countries, India, China, Brazil, and South Africa have had some advantages in managing the epidemic; the world’s poorest countries may be able to adapt some of these approaches to change the tide in their countries. As these four countries move forward, they must lead by example and show other countries how to face the challenges that still remain in ensuring sustainability, fighting stigma, and reducing drug costs and, hopefully one day soon, immunization prices.
Jeffery Sachs closed the discussion, saying: “We are at a vital crossroads; the Global Fund is in financial crisis.” He encouraged the presenters not only to be the voice in public health, but within the leadership of The Global Fund. He asked the countries to invest in The Global Fund, so the world can continue to see significant changes in the fight against AIDS, Tuberculosis, and Malaria.
Margaret Hartley is MSH’s knowledge exchange associate.