Key figures in the AIDS response came together at the 54th meeting of the UNAIDS Programme Coordinating Board (PCB) to discuss how to ensure that the gains from the HIV response can be sustained beyond 2030.

During the PCB’s thematic segment, participants heard that the aim of sustainability is not to maintain the HIV response in its current form but to ensure the durability of the impact of the HIV response. This will require a shift in focus to long-term sustainability.

“Until there’s a cure or a vaccine, we will need to sustain the AIDS response beyond 2030, in every part of the world, in the north and in the south,” said Winnie Byanyima, UNAIDS Executive Director.  “Sustainability is at the heart of the vision of the Sustainable Development Goals (SDGs), with the commitment that the needs of the present are met without compromising the ability of future generations to meet their own needs.”

Remarks echoed by Florence Anam, co-Director of the Global Network of People Living with HIV (GNP+), “People living with HIV will be here in 2031 and beyond so for us the sustainability of the HIV response is a journey of transformation and not a destination with an end date,” she said.  “It matters that at the center of this process of change, mechanisms are in place for all who need treatment and prevention services and that this care is inclusive, devoid of stigma and discrimination.”

The strategies and delivery mechanisms required for scaling up prevention and treatment services and to ensure a stable enabling environment to reach the 2030 target will differ from those that will be needed for long-term sustainability. Leveraging societal enablers will be especially critical for sustainability, including minimizing HIV vulnerability and ensuring access to services in future decades. Rather than build incrementally on what is already in place, sustainability will demand transformations in human rights based, people-centred policies, programmes and systems.

In addition, sustainability requires action on the political, financial, and programmatic front – and across sectors. Not only health, but also gender equality and education so that the economic and societal drivers of new infections are tackled.

Michelle Bachelet, former President of Chile, in a video statement, said, “The combination of shared responsibility and country leadership is essential. Developing countries need to own the response and increase their self-reliance but global action is required to create an enabling environment for this to happen.”

Countries are being advised to prioritize the careful and effective integration of the HIV response in national health systems, with appropriate attention to reforms or modifications required for key and vulnerable populations. This transformation will increase efficiency, promote equity, maximize resource utilization and contribute to the dual goal of achieving and sustaining HIV epidemic control and strengthening human rights based, people-centred systems for health.

Together with its co-sponsors, partners such as PEPFAR and the Global Fund, and other stakeholders, the Joint United Nations Programme on HIV/AIDS are supporting countries to develop roadmaps to sustain their national AIDS responses.

"Sustainability road maps are critical, starting with the vision,” said Peter Sands, the Global Fund Director. “Strategic financing then needs to support the path to that vision, focused both on continuing to raise resources as well as using those that are available more efficiently. To optimize HIV and primary health care integration requires well- coordinated partnerships between governments, private sector companies, international organizations, and non-government organizations.”

John Nkengasong, U.S. Global AIDS Coordinator and head of PEPFAR, also stressed that gains in the HIV response are fragile and need to be sustained. "Today we find ourselves at a crossroads to 2030 where we go somewhere or we go nowhere,” he said. “2030 is critical because at that point the global community regardless of where people are sitting, either say we have done our best and we don’t know what else to do or do we say, ‘Yes, we can get to the finish line’...2030 is a mountaintop moment.”

Finally, sustainability will also require adapting measures and approaches in diverse settings, highlighting the importance of tailoring planning and implementation for specific contexts.