As we reflect and take up calls of action this week for the 23rd annual World AIDS Day, I'm reminded and in awe of the many "simple" acts that we can undertake to limit the destructive capacity of HIV/AIDS. And of course, I'm inspired by the incredible energy and passion of the millions of individuals and countless organizations across the world who are determined partners in the ongoing struggle against HIV/AIDS.
Yet, as I watch television or read the newspaper and learn about the many dimensions of the disease and the countless ways it affects families and communities, I also must recognize that the sheer number of those "simple" acts create a very complex dilemma. In a world of finite resources, how do we determine what's most important? Which of these "small" needs should we act upon first?
In my own experience as a minister in the South African government and non-executive Chairman of the Development Bank of Southern Africa, I've seen the ravages of HIV/AIDS first hand. It is certainly not with pride that I admit that South Africa is believed to have the largest number of citizens of any nation in the world infected with HIV/AIDS -- nearly 12 percent of the population, as estimated by the United Nations. But it does provide perspective on where our most urgent challenges lie, and which small steps can have the greatest impact.
Where I personally look - and what I encourage others to consider as well -- is the start of life. That is to say, whether it's preventing a combination of HIV/AIDS and other diseases (i.e., malaria, TB, etc.), fighting the rampant spread of misinformation, or responding to the lack of prevention strategies that can counter the spread of disease, most of these "simple" means of pushing back against the global epidemic of HIV/AIDS occur during teenage years or adulthood. But where a person's capacity for a normal, functioning life is either made or broken is pregnancy and the first 24 months after birth. Those first 1,000 days are the most critical.
The relationship between malnutrition and AIDS is undeniable. HIV infection diminishes nutritional health in two, mutually-reinforcing ways: it decreases appetite and the body's ability to absorb critical nutrients leading to weight loss and malnutrition. When these occur it often leads to death.
In the dialogue today, we need to be sure that we aren't just talking about the numbers of individuals and communities afflicted. In order to shrink the mind-numbing figures, we must focus our minds on solutions. South Africa has instituted a national HIV testing campaign that assumes all individuals are negative until proven positive, as well as a program that has increased demand for anti-retroviral therapy and expanded treatment to more than one million individuals. The world is experiencing a new sexual revolution and public health imperative, creating an opportunity to develop global, national and community strategies to promote responsible sexual behavior. Leaders both at a national and community level can work to develop comprehensive approaches to sexual health promotion.
We need to also discuss more deeply the relationship between food, nutrition and HIV/AIDS, and increase awareness around the combined effects of malnutrition and HIV on the immune system. In resource-constrained settings, HIV infection combined with pre-existing malnutrition can deeply impact an individual's ability to remain healthy and productive members of their communities. Malnutrition and HIV negatively affect each other in a vicious cycle. Solutions exist to support dietary means of reducing the progression of HIV to AIDS and morbidity, and we must more robustly support these initiatives. Improving and maintaining good nutrition can prolong health and delay HIV disease progression. Nutritional supplements can improve immunity and HIV-related outcomes, especially in those populations that are nutritionally vulnerable.
We must look at the drivers of social inequality -- the lack of hope, empowerment, opportunity and voice among the youth that are the breeding grounds for disease and conflict. These inequities are at the root of the global health challenges we face. I encourage you to take time this week to remember those who have lost their lives to AIDS, consider what you can do to help those living with HIV, and take action to ensure we are addressing social inequality as a means of prevention.