When the first people living with HIV were recognized in 1982, the world’s health systems were not prepared to address a new and rapidly expanding epidemic. Almost 40 years after the appearance of AIDS, much has changed. AIDS-related deaths continue to decline as antiretroviral treatment coverage rose to 62% in 2018.
These gains, among other advances in health, have inspired the world to take on an even more ambitious task – to achieve universal health coverage (UHC) by 2030. The HIV response has much to benefit from expanded health coverage, particularly to ensure long-term sustainability of our efforts. Keeping in mind the transformative lessons of the HIV response, the global community needs to approach the UN High-Level Meeting on UHC by uniting around the six key asks.
Ask 1: Ensure Political Leadership Beyond Health – Commit to achieve UHC for healthy lives and well-being for all at all stages, as a social contract.
The HIV response and the broader Millennium Development Goals agenda changed global understanding of what is possible in the realm of health – showing what could be achieved through international solidarity, political leadership, community engagement, people-centred approaches and evidence-informed action. That same spirit must animate our effort to achieve UHC.
Ask 2: Leave No One Behind – Pursue equity in access to quality health services with financial protection.
Expanding health services without addressing the needs of the poorest and most marginalized will fail to achieve coverage that is truly universal. The HIV response has much to give regarding reaching the most vulnerable – such as tailored programmes for key populations, including men who have sex with men, people who inject drugs, sex workers and transgender people; building capacity and leadership of affected communities; and implementing differentiated service delivery models that draw on community resources to expand the reach and impact of treatment and prevention programmes.
Ask 3: Regulate and Legislate – Create a strong, enabling regulatory and legal environment responsive to people’s needs.
At its core, UHC draws on the recognition that every human being has an inalienable right to well-being and quality health care. Although much remains to be done to address human rights barriers in the context of HIV, the HIV response has demonstrated how a human rights-based approach is fundamental to improve health and well-being. Both in the case of HIV and in the broader push to expand health coverage towards UHC, focused and sustained efforts are needed to address structural barriers, reduce stigma and discrimination, and ensure access to justice when human violations occur.
Ask 4: Uphold Quality of Care – Build quality health systems that people and communities trust.
Healthcare workers, including clinical officers, nurses, community healthcare workers and peers, have been front and centre in the HIV response. Critical to achieving UHC will be ensuring that all cadres of healthcare workers are equipped to provide high-quality, stigma-free and client-centred HIV and other health services. To promote both access and quality, the HIV response has increasingly decentralized health services, shifting clinical tasks to trained community health workers, and mobilized peer workers who are adept at reaching key populations, adolescents and young people.
Ask 5: Invest More, Invest Better – Sustain public financing and harmonise health investments.
Findings from the recent International AIDS Society-Lancet Commission found that integration of HIV and other health services can be cost effective for improving both HIV and non-HIV-related health outcomes. The Global Fund results show how investments in multiple disease areas have saved 32 million lives and contributed to health systems strengthening. UHC supporters should help to enable full replenishment of The Global Fund in 2019. Increasing domestic investments in health is an urgent necessity, and financial barriers to health service access, including user fees, must be eliminated.
Ask 6: Move Together – Establish multi-stakeholder mechanisms for engaging the whole of society for a healthier world.
The UHC movement must include meaningful participation of communities and civil society. Gains in the HIV response have been made through the collaboration of diverse stakeholders united by commitments to inclusivity, transparency and accountability, with the meaningful engagement of people living with HIV, civil society and healthcare workers. It has revealed what is possible when activism, political leadership, science and community-driven responses come together to challenge the status quo and make evidence-informed and human rights-based decisions.
Critical lessons can be learned from both the failures and successes of the HIV response on the road towards UHC. The UN High-Level Meeting on UHC is an opportunity to unite around access to quality and affordable health services for everyone, everywhere, while maintaining an unwavering commitment to the right to health for all, including people living with and affected by HIV.
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