At the beginning of the 1980s, before HIV had been identified as the cause of AIDS, the infection was thought to only affect specific groups, such as gay men in developed countries and people who inject drugs. The HIV virus was first isolated by Dr Françoise Barré-Sinoussi and Dr Luc Montagnier in 1983 at the Institut Pasteur. In November that year, WHO held the first meeting to assess the global AIDS situation and initiated international surveillance. It was then that the global health community understood that HIV could also spread between heterosexual people, through blood transfusions, and that infected mothers could transmit HIV to their babies.

During the first decade of the response, it became increasingly evident that an effective HIV response required a multisectoral response: to tackle marginalization, stigma and discrimination, to address the economic, social and security threats of a rapidly expanding pandemic, and to generate the necessary human and financial resources to sustain worldwide action. In 1996, UNAIDS (the Joint United Nations Programme on HIV/AIDS) was established to lead a multisectoral response. In 2000, the United Nations General Assembly adopted the Millennium Development Goals, which committed to ‘halting and reversing the AIDS epidemic by 2015’. In 2002, The Global Fund to Fight AIDS, Tuberculosis and Malaria was established as a financing mechanism to attract and invest resources to end these three diseases. A year later, in 2003, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) was launched, the largest ever bilateral international health initiative.

Condoms have been a basic but critical tool in prevention. In many communities of men who have sex with men, and sex workers, awareness-raising meant that the use of condoms became the norm. However, this messaging is not as strongly pushed now, and a new generation is growing up without being fully aware of the benefits of using condoms, and many countries have shortages. The introduction of harm-reduction programmes (including needle and syringe programmes and opioid substitution therapy) in a range of cities in the mid to late 1980s prevented and reversed explosive HIV epidemics associated with drug injecting, but such effective public health programmes face legal barriers and a lack of political will in many countries, resulting in very low coverage in most countries. Voluntary medical male circumcision, which provides 60% life-long protection from HIV has been rolled out in high burden countries in East and southern Africa benefitting more than 20 million adolescent boys and men.

Stigma remains a fundamental barrier in fighting HIV, believes HIV-positive ABC news broadcaster Karl Schmid, who says that “much of the fear and stigma that surrounded the AIDS epidemic of the 1980’s and 1990’s still exists. Many people still believe that it is a death sentence”. Schmid came out as HIV-positive earlier this year, and has faced enormous stigma: “I’ve had everything from drinks thrown in my face to being told I was “dangerous” over the years. We don’t ask diabetics to provide their health records. So why do we still have this fear and nervousness when it comes to HIV-positive people whose treatment has resulted in the viral load becoming undetectable in their blood? The answer is lack of education, conversation and the stigma associated with being HIV-positive.”

“The challenges in the years ahead are clear: we need to reach the 25% of people who have HIV and don’t know and support them to test and link to treatment. We need to increase access to prevention – to condoms, to voluntary medical male circumcision, to harm reduction and to PrEP. We need to prioritize HIV services for vulnerable and hard-to-reach groups such as people in prisons, people who inject drugs, men having sex with men, transgender people and sex workers. These key populations continue to be left behind, not benefiting from the huge advances in HIV testing, prevention and treatment made over the past 30 years” says Dr Baggaley.