The big push to try to combat Aids

initiative “is nothing less than the end of the Aids epidemic by 2030”.

“There is no doubt 90-90-90 will improve outcomes worldwide in a short space of time,” says Bekker. “We have closed down epidemics in parts of the world. We have to tick off the boxes – done, done, done.”

However, Bekker cautions not to “send the message that we can simply treat our way out of global epidemics”.

“Rochelle Walensky has made the point that it’s clear that even if we don’t achieve the stretch goal – ending Aids – this initiative will still have helped a lot of people who might not have been and who would have died.”

Walensky is associate director of the Programme in Epidemiology and Outcomes Research at the Harvard Center for Aids Research in the US.

Bekker, along with Walensky, was one of several contributing authors to a paper published in May titled “The Anticipated Clinical and Economic Effects of 90-9090 in South Africa”.

This assessed whether the initiative could be implemented successfully in the country with the highest number of people living with HIV/ Aids – around 7 million in 2015, with more than 2 million HIV/Aids orphans.

South Africa also has the largest antiretroviral (ARV) treatment programme in the world.

It’s a big ask and, cost apart, there are other hurdles. “You need resources, you need logistics – it’s a huge challenge,” says Bekker.

However, she and her co-authors state that the “performance targets are ambitious but plausible” and “emerging evidence suggests that best practices can be implemented and sustained in resource-rich and resource constrained settings”.

The estimated cost in South Africa is “$54 billion over the next 10 years – an increase of $16bn over

The estimated cost in South Africa is “$54 billion over the next 10 years – an increase of $16bn over HIV detection and treatment efforts.” But according to Bekker the cost must be balanced against the risk benefits: how many lives will be saved, how many children will not become orphans? current HIV detection and treatment efforts”.

But according to Bekker the cost must be balanced against the risk benefits. “How many lives will be saved, how many children will not become orphans?”

The cost is undeniably huge. And they will already have risen – the paper’s figures are based on the dollar-rand exchange rate in 2014.

“Last December’s banking crisis in South Africa saw the cost of ARVs go up overnight. Basic ingredients that are made overseas have to be purchased from there. Plus, there are other escalating costs, including wages for doctors and nurses.”

The costs will also rise as more HIV-infected people are identified and go on to ARVs. But Bekker is “chuffed” at the South African government’s support in the fight against HIV/Aids. “Health Minister Aaron Motsoaledi doesn’t want South Africa to be behind the curve; he wants to be ahead of the World Health Organisation guidelines.

“And I must give kudos to the present administration who, from 2008, have been determined to own the problem. They realise we are a middle-income country and we should be able to handle this on our own. But the needs here are more than any other country and that behoves government to be circumspect as to where and how they place their priorities.”

Nor is HIV/Aids a stand-alone disease. Others, such as TB, are also part of the HIV/Aids scenario, as is global warming, which has seen a resurgence of malaria.

“We have to get malaria under control,” says Bekker. “Malaria and tuberculosis have taught us you can’t simply treat your way out of an epidemic.

“The three illnesses are an unholy triad. They coexist, causing increased morbidity and fatalities.”

Eradicating them involves far more than treatment. “Social and economic issues also have to be addressed.”

Such issues account for the theme of this year’s conference: access equity rights now.

There are 37 million HIV/ Aids-infected people worldwide; 16 million are receiving treatment. That means 21 million people do not. “We need to find these people and move them to the top of the tree. We’ve got to plug the gaps.

“No one must be left behind, whether it be someone in the Ukraine or a gay man in a village in Kenya – they must have access to prevention and treatment. Unless we get to these people we can’t talk about ending an epidemic.”

Equity means equality in accessing prevention, diagnosis and treatment, says Bekker.

“While that usually means girls and women, it’s important we don’t leave men out of the discussion. If we don’t get the message across to them, we’re in danger of absolving men from their role in the epidemic. They then think they don’t need to know their status, they don’t need to use condoms, and so on. Women don’t get HIV on their own.”

Bekker says it will be a “poignant” conference for her because taking up the presidency means “I will have to leave South Africa, and I am proud of our achievements here”. She will be based in Europe, moving between Paris and Amsterdam.

As incoming president, Bekker says “it is urgent to reaffirm the passion around this epidemic”.

“We are at a crucial moment, the glass is half full, we mustn’t let it dribble away in apathy and non-commitment.

“I also want to fire up the generation behind us. The science is invigorating and the prevention work is fascinating but I worry that those coming up don’t have the same passion to fight the disease as those of us who were in at the beginning.”

What keeps Bekker passionate? “I’m motivated by that extraordinary resilience we find in individuals and in our communities. People courageously dealing with a lifechanging event every day of their lives.”

This article was generated by MedicalBrief, a weekly, online, open access African medical news digest.