An agenda for the future
Fighting AIDS on a global scale, Clark is leading a new initiative charged with anticipating and influencing the future of AIDS
No one can argue that aids has not had a dire effect on the world. For the last 25 years, medical communities worldwide have been working to harness the virus. According to the Joint United Nations Programme on hiv/aids (unaids), the number of people living with hiv continues to rise. Currently, there are more than 33 million people in the world living with hiv, with 2.5 million new infections and 2.1 million aids deaths in 2007 alone. This was more than in any previous year. Although some areas of the world have been affected more directly than others, few communities have remained completely unscathed. The indifferent reach of the disease knows no boundaries. And the complexity of this killer coupled with the complexities of a changing world leave aids researchers investigating not only geography and medicine, but also a whole range of drivers in search of answers to the questions: "Where will aids be in 25 years?" and "What can we do differently now to change the face of aids in the future?"When tough questions need to be answered, it's typical of Clark researchers to be at the fore of discovery. Clark is collaborating in a new global consortium, aids2031, an initiative charged with examining the current and future landscape of AIDS and reshaping how people in the development and medical fields think about the next 25 years of AIDS and how they will respond. The year 2031 will mark 50 years since the first case of AIDS was reported.
"Considering what we want to do with aids2031, it is nothing less than influencing the course of history," says Peter Piot, UNAIDS executive director and undersecretary general of the United Nations.
aids2031 is a consortium of partners who have come together to examine what has been learned about the AIDS response over the last 25 years and to consider what implications the changing world will have on the future of AIDS. The aim is to generate new evidence to inform and chart options for the long-term response.
Despite more than 25 years battling this crisis, and some real results, HIV continues to spread and destabilize whole sections of the globe. aids2031 aims to take a longer term, more comprehensive view of AIDS in the context of global health as well as consider socioeconomic and political drivers. aids2031 brings together economists, epidemiologists, biomedical, social and political scientists, and communication experts to generate new thinking about AIDS.
According to Piot, it is time to shift today's global AIDS response from a short-term crisis management approach to include planning for a long-term sustained response.
"While global warming is moving from being a long-wave to short-wave phenomenon, we are seeing AIDS move from being a short-term emergency to becoming a long-wave phenomenon," he says. "We must look at what we can do differently now in order to influence the future face of AIDS."
UNAIDS tapped Clark to host the aids2031 Project Management Unit and backed it up with several grants now totaling more than $2.7 million, noted principal investigator IDCE director William Fisher. Headed by IDCE professor Heidi Larson, the unit, with offices on Clark's campus and in New York City, coordinates and supports the work of nine working groups to challenge conventional wisdom, stimulate new research, encourage public debate and uncover new evidence.
"Clark is pleased to be able to take on a leadership role in addressing this important social problem," says Provost David Angel.
For the next two years, aids2031 researchers will revisit some of the assumptions that were made about AIDS during the first 25 years of global response.
"A lot has changed in the medical and technology fields as well as in the geopolitical environment, so we want to investigate what new approaches we need to take," explains Larson. "With a critical look at past and current responses and in light of world changes, we hope to learn how we can influence the state of AIDS at its 50-year mark, in 2031."
Larson says aids2031 will take a special look at youth. One reason is because today's teens are entering a critical stage in their sexual and social lives. Identifying and encouraging emerging young leadership will be a key part of the project, she explains, as the responsibility of the global AIDS response is changing hands. While one aids2031 group is investigating leadership, others will examine financing, social drivers, modeling the epidemic, programmatic response, science and technology, communication, and the special needs of hyperendemic countries and countries in rapid economic transition.
Clark's IDCE Department and George Perkins Marsh Institute are hosting the Social Drivers Group in collaboration with the International Center for Research on Women (ICRW), which is funded by two separate grants channeled through UNAIDS totaling $650,000. This working group, co-convened by Fisher and ICRW director Geeta Rao Gupta, will examine the underlying social, political and cultural injustices that allow AIDS to thrive in certain areas of the world.
"These vulnerabilities include gender inequity, economic marginalization, stigma and discrimination—all things that fuel the spread of AIDS and other health crises," explains Fisher. The group aims to understand the social changes brought about by the impacts of HIV/AIDS on societies. At the same time, it will look at the potential of positive social change to redress inequalities and imbalances in power to slow the pace of the epidemic and mitigate its negative impacts.
"The theme of global health and social justice is important because they are inextricably linked," adds Larson. Global health problems can be a symptom of underlying problems that reach far beyond disease—poverty, environmental issues, access to clean water and societal stress.
"A closer look at global health issues will inevitably uncover social injustices. This offers researchers the opportunity to address these injustices through the universal window of health. Some injustices are too sensitive for exploring in certain cultures—such as sex workers and gay communities—but a killer disease like AIDS demands the voices of marginalized groups to be heard."
Within the last year, Clark has been involved with building aids2031 energy, knowledge and public presence. The aids2031 initiative helped launch Clark's thematic focus on global health and social justice. Last year, Clark presented a series of talks and presentations related to the topic. In summer 2007, Clark hosted two Social Drivers Group meetings on campus, involving multiple partners from all over the world. Last fall, a multidisciplinary team of IDCE faculty taught a graduate-level research seminar on aids2031, which explored various aspects of HIV/AIDS.
During the course of the project, Fisher expects that IDCE faculty and students will have other opportunities to contribute to the project through additional courses, events and practice-oriented research.
"Mobilizing our research capabilities to make a difference in the world is central to the mission of Clark and we are delighted that the aids2031 project also serves as a platform for student learning," notes Nancy Budwig, associate provost and dean of Graduate Studies and Research.
Over the next two years, the aids2031 initiative will conduct a series of think tanks, public conversations, broadcast dialogues and programming, youth summits, original research, as well as Web-based discussions designed to get people throughout the world thinking about the question, "How can we best prepare for and live with AIDS in the future?"
In 2009, the work of aids2031 partners will culminate with the release of "An Agenda for the Future," a report of their final recommendations. It is hoped that these recommendations can guide countries as well as donors as they plan for the future response to AIDS.
"The world has been managing the global AIDS epidemic for more than 25 years," says Larson. "While great strides have been made, there are still persisting as well as emerging challenges that must be addressed."
For more information visit: aids2031.org
How will aids2031 work?
aids2031 partners are organized into nine working groups charged with examining a series of key questions in nine significant areas. The outcome of each group's work will be the basis of the final report, "An Agenda for the Future." The following, though not exhaustive, represents some of the questions they will explore:
MODELING THE EPIDEMIC
- What evidence is needed to understand the spread of the virus and how might this change as responses to the epidemic unfold?
- What are the impacts of migration, internal disruption, urbanization?
- What are the impacts of HIV directly and indirectly on other diseases?
- What will be the impact of new prevention technologies and treatments?
SOCIAL DRIVERS
- What are the true underlining drivers of the epidemic?
- What is the likely role of young people in a movement to mobilize change?
- How are new communication technologies and new forms of translocal and transnational civil society networks pushing change on the one hand, and, on the other, refusing changes which are perceived to be imposed from "outside?"
PROGRAMMATIC RESPONSE
- What are the obstacles being faced in current AIDS programs?
- Where have responses gone wrong?
- What is working, and what will remain viable for the long term?
- How can programs be better contextualized in the broader development agenda?
- What are the current and possible future challenges?
LEADERSHIP
- Who is really setting the agenda, formulating the focus areas and deciding on how/where the money is spent?
- What kind of leadership will there be in the future? Who will be influencing the choice of investments/research development?
- How can we foster new, longer term visions beyond the electoral cycle and stimulate sustainable, informed leadership – both locally and globally?
FINANCING
- How much will the epidemic cost?
- What are the future financial needs and who will pay?
- How do macroeconomic policies and international development practices impact AIDS funding?
SCIENCE AND TECHNOLOGY
- What is in the pipeline and what will be the programmatic and financial implications?
- How can local communities be more engaged in efficacy and effectiveness trials and in building demand for newly available interventions and technologies?
- How can programs better anticipate and prepare for the introduction of new technologies and interventions?
COMMUNICATION
- How best can we influence public beliefs and attitudes about AIDS during the next 25 years?
- With dramatic growth in communication infrastructure, how do we engage those people able to jumpstart a revolution aimed at fighting AIDS with new communication tools?
- What new communication leadership is needed and how do we galvanize it? How do we hear new voices and reach those who previously have not been heard? Can we create a sense of collective responsibility at societal levels?
Other working groups will be taking a cross-cutting look at the above issues through the lens of hyperendemic countries and countries in rapid transition.
Excerpted from aids2031.org
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