Documenting the history of the response to the AIDS Pandemic: An interview with Michael Merson and Stephen Inrig, authors of The AIDS Pandemic: Searching for a Global Response
What inspired you to write the book?
Mike: Having led WHO’s Global Programme on AIDS (GPA) for five years, I felt GPA’s work – started by Jonathan Mann in 1986 – remained untold and overlooked. I wanted to be sure that we learned from our experience during those years, especially since the global health community continues to face complex health challenges not unlike the ones AIDS initially posed.
Stephen: I agree with this, adding that I wanted to capture the untold stories of GPA staffers who had devoted their lives to AIDS, thereby creating a history that policy-makers and health leaders might use to address present and future health and governance concerns.
What do you consider to be the most important developments and outcomes from the history of the global response to AIDS? What can HIV/AIDS researchers (across disciplines) learn from your book?
Some of the most important developments and outcomes include: the rapid identification of HIV as the cause of AIDS; the development of highly active antiretroviral therapy (HAART) in the 1990s (transforming AIDS into a chronic disease); and the successful use of Pre-exposure prophylaxis (PrEP) in certain settings. Additionally, developing the “health and human rights” framework elucidating the role of discrimination and inequality in the spread of HIV, while integrating community-based organizations and people living with AIDS, helped shape an effective response. We also learned the importance of integrating a multidisciplinary approach, social determinant perspectives, and affected communities into research strategies.
What are your thoughts on the future of the global response to HIV/AIDS?
This is a critical time. The disease continues to spread, particularly in Southern Africa and Eastern Europe. With the success of treatment, a sense that the pandemic is behind us has developed. The challenge is to maintain our commitment to AIDS while supporting universal health coverage and the health related Sustainable Development Goals. We can do this by investing in prevention and treatment while finding new efficiencies and multisystem collaborations that allow us to respond concurrently to AIDS and other health problems. We also must continue our research to find an effective vaccine and cure.
How might your book help to inform or influence the response to some of today's leading global health issues?
We wrote the book to explore how institutions and nations responded – productively and otherwise – to AIDS. We highlighted many of the weaknesses in the global response over the past three decades: extensive duplication; inadequate international coordination; short-term funding cycles from donors; insufficient harmonization between donor and national goals; and overreliance on biomedical approaches at prevention’s expense. Much of this involves reforming UN agencies, particularly UNAIDS and WHO, and encouraging donors to develop sustainable long-term multilateral strategies and funding commitments. It also requires new ways to address global health emergencies that circumvent the structural inefficiencies of WHO and other UN agencies.
What do you consider to be the most significant takeaway(s) for readers of your book as we reflect on World AIDS Day 2018?
We believe the global health community is capable of responding effectively to AIDS and other global pandemics if there is strong leadership and donors are prudent, patient, and willing to understand the many challenges this entails. At the same time international organizations and the donors need to live up to their institutional and financial commitments. We have also learned that responses to global health crises should be comprehensive, balanced and evidence based. They must combine biomedical, behavioral and human rights-based strategies and link health professionals with civil society. In the end, countries must craft plans that are tailored to local needs.
Read this chapter from the book for free until December 10: Containing the Global Spread of HIV