Now is a critical moment in the fight against HIV/AIDS. Despite frequent proclamations that the end of AIDS is within reach—and a pervasive sense among much of society that HIV is a treatable disease—the job of controlling this most devastating of epidemics is certainly not done. Around 2 million people are newly infected with HIV each year. Access to treatment in key populations is stagnating. Too many people entering HIV care are lost to follow-up. Millions of people living with HIV are underserved at best, ignored or stigmatised at worst. Moreover, as HIV disease evolves to become a chronic infection for those receiving treatment, the interaction of the virus and its medication with other chronic conditions will present a host of new challenges. The Lancet HIV is a journal for a new era in the history of HIV/AIDS.
Since the beginning of the HIV/AIDS pandemic, The Lancet journals have been privileged to publish some of the most important advances in our understanding of the virus and its treatment. We have also sought to strengthen crucial linkages across the community, recognising the importance of not only the best science, but also the parts civil society, patients’ organisations, research scientists, and governments can play in combatting the disease. Given the strong history that The Lancet titles have in the field of HIV/AIDS, why launch a dedicated HIV title? And why now?
Although major advances to control the epidemic have been made, the future of the fight against HIV/AIDS remains deeply uncertain. Scientists and policy makers fell victim twice before to complacency in their efforts to eliminate or eradicate malaria and tuberculosis—diseases once thought to be controlled and in terminal decline. Both diseases held on and returned to puncture our hubris, exacting enormous tolls of human disease and disability. There is a very real danger that the same history could overtake the future of HIV/AIDS.
Despite all that is known about prevention, the 2 million people newly infected with HIV each year are symbolic of our collective failure. While many people are able to start lifesaving treatment, health systems are failing crucial populations. Access to antiretroviral treatment for pregnant women is no longer accelerating as it should be. UNAIDS justifiably says that the global community is failing children, with only a quarter of those in need actually receiving lifesaving medicines.
Worse still, the protections for those at risk of, or living with, HIV/AIDS are being eroded across the world. As governments reverse advances in human rights for lesbian, gay, bisexual, and transgender people, access to prevention and treatment services becomes harder, rendering ongoing transmission of HIV among these groups a near intractable challenge. Stigma and discrimination further marginalise those most at risk.
As more people start treatment and live longer, the chronic effects of infection and treatment will begin to reveal themselves. The first cohorts of perinatally infected infants are now entering adolescence and young adulthood, emphasising the difficulties in linking paediatric with adult care. The interactions between infection, antiretroviral therapy, chronic non-communicable conditions, and diseases of ageing will present a host of unknown predicaments.
2015 is the year for completion of the UN Millennium Development Goals. The political agenda for global health will then switch to targets set out in the Sustainable Development Goals. With over 30 million people worldwide living with HIV, any consideration of the meaning of sustainability must include a bold vision for addressing this epidemic. How will treatment be scaled up for those most in need? How will health systems cope with an ageing HIV infected population? How will societies become more inclusive of the ever growing HIV/AIDS population? And how can vertical health initiatives be creatively adapted to provide platforms for universal health coverage?
The Lancet HIV will build on The Lancet‘s rich history of publishing HIV/AIDS research to provide a reliable foundation for advocacy and for programmatic and political change. The journal will publish the best translational, epidemiological, clinical, and implementation research. Most importantly, the journal will aim to unify these disciplines across a single vision for the health of those living with HIV. The Lancet HIV has been founded on two clear principles. First, the task of defeating HIV has not been accomplished and the journal will work in partnership with others to accelerate our response immediately. Second, The Lancet HIV is a new journal intending to reposition HIV/AIDS for a new era of sustainable development. We invite you to join us in this two-fold mission.