Last August I wrote a posting about the important role of communications during the initial stages of an emerging contagious or communicable disease. But communications not only serves a vital purpose at the beginning of an epidemic, it also does so when you are trying to end one.
As mentioned in the Weekly Roundup last week, the World Health Organization (WHO) has announced a new guideline document related to HIV treatment. By expanding access to antiretroviral treatment (ART) both for people with HIV and for people at high risk for HIV by offering pre-exposure prophylaxis (PrEP), WHO is aiming to avert more than 21,000,000 deaths and avoid 28 million new infections by 2030, effectively altering the face of this epidemic as we have known it. The aim is breathtaking. But the road for getting there is not going to be as simple as handing out pills.
A great deal needs to accompany medication. First of all, it requires policy support for expanding access and to commit to it once it is expanded. The costs associated with a lack of such commitment are evident when looking back to the world’s experience with tuberculosis and the emergence of multi-drug resistant TB. Once commitment falters, risk rises. That is perhaps the first role here for communications – one of effective advocacy for both expansion and long-term commitment.
The other is in education. The call for expanded access is premised on the results seen in clinical trials where the use of treatment as prevention was successful. But in real world circumstances, patient education and on-going support is going to be essential to success. WHO recognizes this, saying in the release that “countries will need to ensure that testing and treatment for HIV infection are readily available and that those undergoing treatment are supported to adhere to recommended regimens and are retained in care.” But it is a point that merits emphasis.
As someone who began his career in the earliest and frightening days of this awful epidemic, the turning of this page is almost difficult to believe. Those early years when there was no treatment – and not even a test – meant you did not know if you were infected. Your only knowledge of your health status came with a diagnosis that meant your immune system was gone. We have come so far in the nearly thirty-five years it has lasted. Progress has been built on good advocacy, good science, good policy and good communications – all of which made happen by the unique application of all the stakeholders. There is a role and a responsibility for each and every stakeholder in seeing this through.
World AIDS Day will take place this December 1. The prospect of the new WHO guideline offers an opportunity to use that day for a really substantive discussion on how the guideline gets supported and maintained by each and every stakeholder involved. It is now about more than a red ribbon to express sentiment. Let’s end this epidemic.