Date Published: December 21, 2018
Publisher: Public Library of Science
Author(s): Joseph J. Amon, Patrick Eba, Laurel Sprague, Olive Edwards, Chris Beyrer
Abstract: In a Policy Forum, Joseph Amon and colleagues discuss human rights indicators for tracking progress toward ending the HIV epidemic.
Partial Text: From early in the global HIV epidemic, we have understood that national indicators of HIV incidence and prevalence represent a sum of the diverse subepidemics affecting different populations according to geography, socioeconomic status, gender, criminalized status, acquisition risks, and vulnerability to rights abuses. Even in countries that report decreases in HIV incidence, incidence may be increasing among groups that are particularly vulnerable and face political and social exclusion, especially sex workers, people who inject drugs (PWID), transgender persons, gay men and other men who have sex with men (MSM), and prisoners (known collectively as key populations) .
In the past 100 years, three disease eradication programs have failed (malaria, yellow fever, and yaws), two are ongoing (guinea worm and polio), and one has been successful (smallpox) . A common cause for failure was inadequate attention to social and political context. Whereas epidemic transition may present a lower bar then eradication or disease elimination, the need to address sociopolitical context remains, and the definitions of indicators in the elimination of vertical HIV transmission and of certain neglected tropical diseases (NTDs) provide useful examples of more-comprehensive approaches.
A hallmark of the HIV response, and a major factor in its success to date, has been the meaningful involvement of affected communities generally, and people living with HIV specifically (often referred to as the greater involvement of people living with HIV or AIDS [GIPA]) . This participation—at all levels, from the local design and implementation of programs to the global governance of such institutions as UNAIDS and The Global Fund—has contributed to effective responses and attention to gaps and challenges that would otherwise be overlooked.
The world is ready to celebrate an “end of AIDS.” It is important to recall, however, that past efforts to define epidemic control may have done more harm than good, undermining realistic planning and policy making. To combat this, a broader, rights-based indicator framework should be at the center of what epidemic transition means. This rights-based indicator framework should both track the factors driving the HIV epidemic and measure our progress from a highly stigmatized epidemic that generates discrimination and human rights abuses to a rational, evidence-informed, and rights-based response that respects the dignity and rights of those living with and vulnerable to HIV.