London School of Hygiene & Tropical Medicine

Peter Piot, Director of the London School of Hygiene & Tropical Medicine, has contributed a guest column in the Financial Times' Special Report, Combating Aids, to mark World Aids Day 2010.

Writing with Heidi Larson, a senior lecturer at the School, and Stefano Bertozzi, Director, HIV and TB at the Bill and Melinda Gates foundation, he calls for a move away from the predominantly global approach to one that is more focused on national and local needs, and calls for renewed leadership amid concerns that leadership on Aids is waning. He also highlights the need for longer budget cycles. 'We cannot continue to address a long-term problem and life-long treatment with annual funding cycles. Budget cycles should move to 10-15 years, while programme indicators should change to measure long-term impact, such as new infections and deaths, rather than just short-term process gains'.

'The real challenge', he says 'will be for leaders to put policies in place to prevent the most infections possible and save the most lives'. The authors highlight a number of recommendations for tackling the pandemic, made in a forthcoming report, Aids: Taking a Long Term View, soon to be released by the aids2031 initiative and published by FT Press on 13 December 2010.

These include:

• Re-emphasising prevention so that new infections (which numbered 2.6 million last year according to the latest UN Aids estimates) are reduced
• Ensuring prevention measures are and informed by 'up-todate local epidemiological and behavioural data'
• Placing anti-discrimination campaigns, campaigns that decriminalise same-sex relationships and harm-reduction approaches at the forefront of anti-Aids efforts
• Increasing efficiency and using available resources more effectively - in terms of optimising treatment and ensuring more efficient programme management
• Continuing to innovate - and to invest in science and technology

They also call for a more businesslike approach to responding to the pandemic, arguing that business practices should be employed to enable rapid feedback on performance at local levels, and ensure continuous, ongoing improvement.

They conclude: 'As we mark World Aids Day, it is crucial to remind ourselves, Aids remains one of the greatest health crises of our time, having killed nearly 30 million people since 1981. There is an urgent need to take a long-term view and make bold changes so millions more do not die needlessly'.