Fatigue and forgetting: Two threats to the AIDS response

By Dr. Kevin De Cock, director of the Center for Global Health at the US Center for Disease Control and Prevention


In a few days more than 20,000 people will arrive in Washington, D.C., to attend the XIX International Conference on AIDS. These biannual conferences provide individuals and agencies fighting HIV/AIDS with a unique opportunity for re-engagement and commitment, education, networking, research dissemination, and overall prioritization.

This year’s conference is relevant in the face of two threats to the AIDS response: fatigue and lack of memory. To some extent we are victims of our own success. When we met in Durban in 2000 for the XIII International AIDS Conference, the gravity of the AIDS crisis in Africa was not yet widely understood—the Conference helped correct that. Notably, at the time of the Durban conference, the concept of universal access to lifesaving antiretroviral therapy had not even been conceived in a dream. Twelve years later, the advances in global health over the last decade are taken for granted.

Lack of awareness about the early devastation of HIV/AIDS is especially acute among young people. A recent New York Times article describes the experience of a Yale alumnus, Christopher Glazek, discovering for himself that many gay alumni, who were living with AIDS in the 1980s, died.

“The thought immediately crossed my mind,” Glazek, is quoted as saying, “that I would likely have died from AIDS too, had I been born 25 years earlier.”

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Last week, I had the privilege of speaking at Dartmouth College for its “Leading Voices in U.S. Foreign Policy” lecture series. I realized that the students in the audience were passionately interested in global health and had never lived in a world without AIDS. They had never known the disease as the inevitably fatal, wasting illness it once was, because they could not recall a time when treatment was not available. Many have forgotten or never have known about the extraordinary impact of AIDS in heavily affected settings, especially in sub-Saharan Africa where hospitals overflowed with dying patients, families were destroyed, and tuberculosis escalated.

Beyond lack of memory, AIDS “fatigue” threatens our response to HIV. One symptom of fatigue can be seen when disease advocates question the money spent for HIV/AIDS when compared to other disease. A more accurate interpretation is that advocacy efforts for other global health priorities have not always been as successful at mobilizing the support needed to address them. Unfortunately, resource gaps still remain to achieve universal access to HIV/AIDS treatment, for earlier initiation of antiretroviral therapy, and for innovative approaches such as “Test and Treat.”

Rather than pitting diseases against one another to compete for limited resources, we can learn from the way that the scale up of HIV/AIDS services has benefitted other parts of the health system—building global capacity for disease monitoring, delivery of medicines and services, translation of domestic and international research into action, and bolstering response to many health threats. The HIV/AIDS epidemic taught us not to accept the unacceptable, and this motivation has spilt over into other areas of global health.

CDC and ONE are among the hundreds of organizations who are working together to achieve the next ambitious goal of an AIDS-free generation. As we gather with our colleagues at the XIX International Conference on AIDS, we must ensure legitimate differences of opinion across diverse constituencies and partners do not overshadow our common goals of universal access to HIV treatment and an AIDS-free generation. By gathering to share new approaches, effective interventions, local solutions, and ongoing challenges, the conference will provide the energy, renewed commitment, and connections necessary to take the next step foward in this long march.