The Commission state that only a massive and rapid expansion of a comprehensive AIDS response by 2020 can achieve the goal of ending AIDS as a public health threat by 2030.
"We have to act now. The next 5 years provide a fragile window of opportunity to fast-track the response and end the AIDS epidemic by 2030," says Michel Sidibé, co-convenor of the Commission and executive director of UNAIDS. "If we don't, the human and financial consequences will be catastrophic."
The UNAIDS and Lancet Commission is a collaboration between political leaders, health and medical experts, scientists, activists and private sector representatives aiming to ensure that lessons learned in the AIDS response usher in a new era of sustainable development.
According to the Commission, in 2013, the number of new HIV infections had fallen by 38% since 2001 to 2.1 million, and the number of AIDS-related deaths had fallen by 35% since 2005 to 1.5 million.
Despite the progress that has been made, however, the report demonstrates that the rate of HIV infection is not falling fast enough.
"We must face hard truths - if the current rate of new HIV infections continues, merely sustaining the major efforts we already have in place will not be enough to stop deaths from AIDS increasing within 5 years in many countries," says lead author Prof. Peter Piot, director of the London School of Hygiene & Tropical Medicine, UK.
He states that although expanding sustainable access to treatment is important, we will not be able to "treat ourselves out of the AIDS epidemic."
"We must also reinvigorate HIV prevention efforts, particularly among populations at highest risk, while removing legal and societal discrimination," he adds.
The need to step up the AIDS response means many countries will need to increase their funding for HIV treatment. However, in low-income countries with high HIV burdens, international solidarity and support will be required for this to happen.
One finding of the report is that sustaining current HIV treatment and prevention programs in the most affected African countries from 2014 to 2030 would cost up to 2% of their GDP along with at least a third of their total health expenditure. In many countries, such financial support is impossible without international assistance.
The report outlines seven key recommendations
The report finds that it is not just those in low-income countries who are vulnerable, however. The Commission identifies a need to ensure people in middle-income countries, and particularly those in marginalized groups, are not left behind.
Some countries have become complacent in their response to AIDS, the report states, and some HIV epidemics that have previously been stable or in a steady decline are now beginning to reverse with reports of new HIV infections rising. Resurgent epidemics have been noted among men who have sex with men in parts of North America, Western Europe and Asia.
The Commission make seven key recommendations concerning future responses to AIDS:
- Get serious about HIV prevention and continue to expand access to treatment
- Ramp up and fully fund AIDS efforts efficiently, with an emphasis on sustainability
- Demand strong accountability, transparency and better data
- Invest in research and innovation in all aspects of the AIDS response
- Reinforce leadership and engagement of people living with HIV, giving them a greater voice
- Find new ways to uphold human rights and address criminalization, decriminalization and stigma
- Promote more inclusive and coherent AIDS and health governance.
If the response to AIDS is accelerated adequately over the next 5 years, the Commission believe that as well as greatly reducing HIV transmission and AIDS-related deaths, incidence of mother-to-child transmission could be eliminated by 2030.
Although the authors found that the AIDS response needs to improve, there are lessons that can be learned from it and applied to future global health crises.
"The movement created by the AIDS response is unprecedented - a system of checks and balances from a people-centered approach is one that more global health institutions should adopt," says Lancet editor-in-chief Dr. Richard Horton. "Identifying multi-sectoral stakeholders early will save time and money by ensuring the best solutions reach the right people."
Whether the fight against AIDS can be won is no longer a question that the experts are asking. Rather, they are wondering will it be won and, if so, when?
"The answers to these questions will eventually depend on the decisions made by leaders and institutions at all different levels, in all sectors and parts of society, and on the personal choices people make in their private lives," the Commission conclude.
Recently, Medical News Today reported on research claiming to have made "a leap forward" in attempts to develop a vaccine against HIV.