Building on the World Health Organization's "3x5" HIV/AIDS campaign, policymakers need to work diligently on ensuring universal access to antiretroviral therapies in Africa, Jim Yong Kim urged a packed audience in Snyer Auditorium during a Dean's Distinguished Lecture on March 2. Kim is chief of the Division of Social Medicine and Health Inequalities at Brigham and Women's Hospital and is Associate Professor of Medicine and Medical Anthropology at HMS.
Kim assessed two major HIV/AIDS public health initiatives in which he played an integral role. The first initiative is the "3x5" plan, which was intended to treat three million HIV/AIDS sufferers by 2005. Kim directed WHO's HIV/AIDS department when he oversaw the adoption of the plan by the agency and by the Joint United Nations Programme on HIV/AIDS (UNAIDS). He noted that the plan did not meet all of its targets, but added that the very act of setting a numerical goal helped spur accountability among governments to address the pandemic. Dean Barry Bloom, who introduced Kim to the audience, emphasized this point: "Jim Kim led the charge to specify targets-the first time this was done in history, for any disease-in his work with the '3x5' plan. Without a number, things would not have happened."
Responsibility for addressing the HIV/AIDS pandemic was reinforced further by framing the issue not only as a public health disaster, but also as a human rights challenge-a connection, Kim noted, made early on in the history of the disease by the late Jonathan Mann, founding director of the François-Xavier Bagnoud Center for Health and Human Rights at HSPH.
"The linkage of health and human rights brought countries into a situation of accountability," said Kim. "It was an absolutely unique moment."
While Kim described setting the WHO's "3x5" treatment target as "catalytic," he also emphasized a second initiative that he feels needs urgent attention-providing universal access to HIV/AIDS treatment for people in Africa by 2010. This goal was discussed last summer at a summit meeting in Scotland by the U.S., U.K., and other "Group of Eight" nations.
Kim is on a Global Steering Committee on Universal Access that is chaired by UNAIDS and the U.K. government. He noted that the committee's intent was to move beyond numbers to focus instead on larger issues. "Universal access could turn the focus to geography, equity, and systems building," said Kim.
Jim Yong Kim
Both the "3x5" and universal access initiatives have been successful in many ways, especially in garnering attention, resources, and hope in developing countries. However, prevention efforts are still inadequate, particularly in comparison to previous public health activity directed against scourges like smallpox and polio. In addition, drug availability remains an impediment to people who seek treatment.
How can these obstacles be overcome? According to Kim, one way is to focus on those actually doing the work of public health in poor countries.
"The key is to bring community health workers into the work force, pay them a decent salary, and make sure they are connected to nurses and physicians in a network that will provide care to everyone," he said.
It is also important to focus on training a generation of future health leaders at home. Kim suggested building a career path for students who wish to become experts at implementing public health programs. "There are lots of new tools for global public health, but if the implementation is not better, public health will worsen since the rich will have access to the new tools and the poor won't," he said.
Another key is to generate the political will and the ability to pay for health programs. One example is Lesotho, an African nation that Kim presented as a case study. Faced with truly intimidating estimates of HIV prevalence ranging from 24 to 29 percent, the leader of this African country has already promised universal access to HIV testing and counseling. However, will wealthy countries match this effort to aid poorer countries in the future, asked Kim.
Most of all, in an age where health and human rights are intertwined, policymakers simply cannot wait to act, Kim concluded.
"We need to bring a sense of urgency that matches the devastation of the epidemics we face," he said.
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Copyright, 2009, President and Fellows of Harvard College
