Editorial

2056 www.thelancet.com Vol 381 June 15, 2013

30 years of HIV: where next?Kuala Lumpur will host the 2013 International AIDS Society (IAS) meeting from June 30–July 3. This issue of The Lancet will be there too, with its content rich in the diverse diaspora that characterises global eff orts to prevent, treat, and ultimately cure the disease that today aff ects 34 million people worldwide.

The emergence of antiretroviral therapy (ART) in 1996 heralded a new era in HIV treatment that continues to this day. The scale-up of ART in the past few years is testament to the extraordinary international public health response to the epidemic. In 2011, for the first time, more than half of people eligible for ART in low-income and middle-income countries were receiving it (54%): the glass is just over half full. But accessibility to ART is only the start of the so-called treatment cascade, where individuals with HIV and country programmes have to be prepared for the reality of first-line treatment failure and the commitment to switch therapy, and to adhere to it. An Article by Mark Boyd and colleagues offers

a welcome new therapeutic option after first-line treatment failure.

HIV prevention eff orts remain key, yet a vaccine remains frustratingly elusive, with the failure of the latest trial, HVTN-505, announced in April. However, a new scientifi c movement is emerging, illustrated by a 2 day symposium attached to IAS 2013 that will discuss new approaches in basic science under an arresting banner: towards an HIV cure. A Review by Rafi ck Sekaly outlines the molecular barriers that currently stand in the way of this goal, and sets out future strategies for ultimately conquering the virus, including the initiation of ART at higher CD4 cell counts, and gene therapy. But as Sharon Lewin rightly articulates in a Comment, expectations must not run away from reality. Although the ultimate goal must be a world free of HIV for all people, rich or poor, our eff orts of the past three decades must be sustained to prevent and treat a disease for which a cure, tantalising though that sounds, almost certainly remains years away. The Lancet

For more on the IAS 2013 conference see http://

www.iasociety.org/Default.aspx?pageId=77

For the 2011 ART data (2012 UNAIDS Report) see http://www.

unaids.org/en/media/unaids/contentassets/documents/

epidemiology/2012/gr2

Leaving home can be a diffi cult decision in some parts of the world. The future is uncertain. Food and shelter may be inadequate. Precarious, cramped living conditions could worsen your health. But for most refugees, there is no choice. Their safety and lives are at risk if they stay.

June 20 marks World Refugee Day, which was established by the UN to highlight the plight of those who are forced to fl ee their homes under threat of persecution, confl ict, and violence. The day should act as a reminder of the most pressing refugee crisis at present: that created by the brutal confl ict in Syria. The UN Refugee Agency (UNHCR) estimates that more than 1·6 million Syrians have been directly aff ected by violence in their country and are now residing in host nations—Turkey, Lebanon, Egypt, Iraq, and Jordan. Women and children make up three quarters of this population.

Furthermore, almost 4·25 million people (out of a population of more than 22 million) have been internally displaced in Syria and are mostly living in overcrowded, unsanitary conditions. Last week, WHO said that it was deeply concerned about the increasing cases of

communicable diseases inside Syria and among displaced Syrians in neighbouring countries. Acute watery diarrhoea in Syria has already increased from 243 cases in the fi rst week of January, 2013, to 660 in the second week of May. And WHO and partners are preparing for outbreaks of water-borne diseases, specifi cally hepatitis, typhoid, cholera, and dysentery.

Access to health care is one of the biggest concerns for Syria’s refugees. UNHCR and its partners are prioritising provision of primary health care and emergency lifesaving interventions, particularly emergency obstetric care. As a letter in The Lancet shows, care is also urgently needed for refugee survivors of rape. However, with the number of refugees in host nations expected to increase to 3 million by the end of this year, overall access to services is likely to become more diffi cult. Health services in these countries are already under an unprecedented strain. Donors must help support these health systems with increased funding, personnel, and medical supplies until a diplomatic solution for Syria allows refugees to return safely. The Lancet

The right to health for Syrian refugees

See Correspondence Lancet 2013; published online June 14.

http://dx.doi.org/10.1016/S0140-6736(13)61137-X

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