The Fastest-Growing HIV/AIDS Epidemic in the World
August 8, 2013
In advance of the many health-related discussions to take place in September at the Clinton Global Initiative, the Social Good Summit, UN week and other such events, the Skoll World Forum asked some of the world's leading voices in global health to paint a comprehensive picture of key trends, challenges and opportunities to realizing healthcare access and treatment around the world.*In partnership with Forbes, a new post will be published everyday through Friday, August 9th. Check back for more!*
Rahim Kanani: When we talk about public health in countries of the former Soviet Union, what should the world know that might surprise them?
George Gotsadze: The Soviet Union managed to achieve significant health gains for its nations under its health care system. But after the Soviet Union fell in 1991, the independent post-Soviet states failed to sustain and expand these achievements. As a result, the health of these nations deteriorated. Tuberculosis (TB) reemerged. Malaria, which was once fully eliminated, came back in some countries. Immunization rates fell, which triggered vaccine-preventable disease outbreaks that spread across borders. And increased heroin trafficking from Afghanistan fueled substance abuse, which was followed by the HIV/AIDS epidemic. According to UNAIDS, this region now faces the fastest-growing HIV/AIDS epidemic in the world.
While over two decades the post-Soviet governments have managed to deal with reemerged diseases, TB and HIV/AIDS yet have not been brought under control, and they continue to threaten the region. Health care delivery systems, which were relatively well developed during Soviet days, deteriorated because the governments weren’t able to adequately invest in capital and human resources. This underinvesting in skilled medical workers and other human resources adversely affected the quality of services patients received and their treatment outcomes. On top of all this, the universally free entitlement to health care that was guaranteed in the Soviet constitution evaporated when many governments could not financially sustain and deliver needed services.
Now, most people in the region face significant financial barriers to getting health care when they need it. Poor health places an enormous financial burden on households, driving them into poverty. It also adversely affects the nations’ economic prospects. While many nations saw significant health gains over the past few decades, according to the World Bank, progress in health among the former Soviet states—as measured by indicators such as life expectancy—has been among the slowest in the world. PATH has been working in some of these former Soviet countries since the mid-1990s to prevent HIV transmission, strengthen TB control measures, improve breast cancer services, and address other critical health needs.
Rahim Kanani: With measurement and evaluation being one of the pillars of 21st century global health investments, in your view, what kinds of health investments have led to the most ‘bang for their buck’?
George Gotsadze: The global initiatives of the past decade—such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, the US President’s Emergency Plan for AIDS Relief (PEPFAR), and the GAVI Alliance—have significantly increased investments in certain diseases and health problems. They have also helped advance the science field and deliver better solutions and services to nations around the world. These initiatives and investments in vaccination and other interventions proved to be effective on a global scale. They’ve helped significantly decrease child deaths, expand prevention and treatment for malaria, reduce the number of new HIV/AIDS infections, and reduce inequities in people’s ability to access health services.
PATH and other organizations like us have made significant contributions to each of these areas, thanks in part to our work with these global initiatives. PATH, for example, works closely with the government of Zambia and other African countries to strategically deploy insecticide-treated bednets, diagnostic tools, and other effective approaches to control the spread of malaria. In Zambia, these measures helped cut in half the rate of malaria among young children in just two years. PATH is tackling malaria from all sides—expanding the availability of high-quality medicines for treatment, advancing a promising malaria vaccine candidate, expanding disease surveillance and diagnosis—to sustain progress, and eliminating malaria is now a very real goal.
All of these achievements are impressive, but I believe we as a global health community need to do even more to maintain and advance these gains.
Rahim Kanani: As Chair of PATH’s Board of Directors, what are some of the ways in which nonprofits can successfully partner with governments in the developing world in order to maximize impact?
George Gotsadze: Nonprofits in both the Western world and the developing world are playing an increasingly important role in reducing health inequities. Their contributions are diverse, from delivering services in the communities where they work, to mounting global advocacy and helping mobilizing governments and societies to respond to the needs of their people. Nongovernmental organizations (NGOs) like PATH, which are advocates for those marginalized by society, are pivotal in attracting governments’ and society’s attention to issues that are important for tackling the health problems of our nations.
As an example, without NGOs, it is doubtful that governments in developing countries will allocate and spend the money needed to prevent and treat HIV/AIDS, or to attend to the needs of the disabled. The most important role NGOs can take is to keep informing governments about societal needs and demanding their attention.
In many instances, NGOs are best placed to respond to a specific need and deliver services, provided that they are adequately resourced. They are also innovators, the ones who develop creative approaches for providing services and interventions in a given sociocultural context. They can help governments find new solutions for a given problem, and help put those solutions into action.
As I mentioned earlier, PATH has worked closely with governments in Africa to put in place effective methods to control malaria, and partnering with governments and communities is part of what PATH has done—and done well—for 35 years. These types of partnerships are vital for developing solutions that are sustainable and that meet communities’ specific needs. That’s how we can maximize impact.
Rahim Kanani: Stepping back even further, where do multilaterals like the World Health Organization fit into today’s global health paradigm? Should they be doing more of the same, or something different?
George Gotsadze: One of the most critical functions the World Health Organization (WHO) performs is developing and setting global norms for medical interventions, which sets it apart from other multilaterals. Obviously this role is important and has to continue. WHO has to respond to new knowledge that constantly emerges from science and implementation.
Multilaterals involved in global health have to remain until their mission is fulfilled. For example, the Global Fund will be needed until we manage to reduce TB, malaria, and HIV/AIDS to the levels where governments by themselves can sustain both the finances and technical expertise needed to provide preventive and curative services.
To respond to countries’ fast-changing realities, these organizations must continuously grow their knowledge base, which demands greater adaptability on their parts. In my personal opinion, developing and enhancing such adaptability becomes necessary for these multilaterals to effectively serve their cause.
Rahim Kanani: Finally, in terms of leadership, how would you rate the U.S. governments’ efforts to advance global health in comparison to other Western countries?
George Gotsadze: The US obviously plays a leading role in advancing the global health agenda as well as funding it. It is only in close partnership and coordination with other Northern and Southern governments that the US will manage not only to maintain its leadership role but also to adequately respond to current and expected challenges in global health.
The world is undergoing major demographic as well as epidemiological transitions. We’re seeing changing disease patterns from the northern to southern hemispheres as well as an increasingly aging population, which will pose future challenges. Advances in science and gains in life expectancy throughout the world will mean a significantly higher demand on the global economy to deal with the health issues of our planet.
All of this will trigger economic challenges and will demand new thinking, innovations, and approaches. Advocacy, both in the United States and in other countries, is becoming a growing body of work for PATH and other organizations. We have to ensure that the US continues to prioritize global health, and we have to keep the pressure on other country governments, too, to advance funding and policies for critical health solutions. The US, as a champion in innovations, should continue to play a leadership role for the benefit of US citizens and the citizens of our planet.