Not many academic lectures begin with a moment of silence.
But the uncharacteristically somber introduction on December 1 at the Yale School of Public Health was to commemorate World AIDS Day.
The disease, which surfaced in the early 1980s, has since claimed millions of lives around the world, and it continues to be a major public health threat. Some 37 million people are currently living with the disease and each year, primarily in low-resource settings, it claims another two million lives.
Keynote speaker Ann Kurth, Ph.D., C.N.M., dean of the Yale School of Nursing and the Linda Koch Lorimer Professor of Nursing, told the large gathering in Winslow Auditorium on that significant progress has been made in reducing the death toll from the disease, but much more remains to be done if HIV disease is to be defeated.
“We’re half way there,” but if we want to eradicate HIV/AIDS, “we need to use data in a granular and dynamic way,” said Kurth, whose research focuses on HIV/reproductive health and global health systems strengthening.
Funding is one of the major challenges. Less than 1 percent of the total federal budget of the United States is spent on foreign aid overall, and Kurth expressed concern that when President-elect Donald Trump takes office early next year, global health funding (including for HIV disease work) could decrease. “I fear there may be defunding, just at the crucial time for turning the tide on the HIV pandemic.,” she said.
Kurth said some strategies moving forward need to be “having access to data and using it well, to scale up what works to get people HIV tested, treated, and to prevent HIV infection in the first place.” She said people “have to stay engaged over the long haul, and care needs to be differentiated, depending on the patient’s need. “We need to move beyond the one-size-first-all model of requiring patients to show up at a clinic once every three months, wait for four hours, and then be tested.”
She advocates HIV self-testing, “an increasingly important tool” that has been used successfully in Kenya. She also suggested allowing patients to be treated in groups and giving nurses more support for team-based care led by nurses, whom the WHO sys provide the majority of healthcare worldwide. “We need to make innovations in health delivery models,” she said. Kurth also advocates more needle-exchange programs and fighting the stigma associated with HIV/AIDS, which keeps people from getting tested, and offering more “youth friendly” services.
“I have concerns that the resources won’t be there because of competing priorities.” She also noted that the world is undergoing radical changes. Urbanization, aging populations, natural and man-made disasters and climate change, and other ecosystem stresses are all altering health care needs and the way care is provided. “We have to maintain our energy and our commitment and not stop until it’s actually over,” Kurth said.
School of Public Health Dean Paul Cleary speculated that every person in the room for the lecture knew somebody who has died of an AIDS-related illness. This is a “deeply personal gathering for me,” he said, recalling that 35 years ago, he worked on an early AIDS-related study. “I figured we’d get to zero in two or three years.“ Instead, he hosts annual World AIDS Day gatherings. He called for a moment or silence to “reflect on the impact and the loss” AIDS has inflicted.
“I hope we never forget the motivation of what we do,” Cleary said.
Kurth’s talk was sponsored by the Yale School of Public Health, the Department of Microbial Diseases Seminar and the Center for Interdisciplinary Research on AIDS at Yale and the Yale chapter of the American Public Health Association.