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I started my medical training in San Francisco in 1982. Like many of my colleagues at that time, I found myself at the center of a terrifying public health crisis, in which a then-unknown virus was killing young men at an alarming rate. Although I was preparing to be an internist and oncologist, I also became an AIDS doctor. That work eventually took me to Uganda to help care for people with HIV/AIDS as the epidemic took hold there.

I am still fighting this scourge, only now on a larger scale, leading the Bill and Melinda Gates Foundation. Our latest Goalkeepers report, a look at the most consequential trends and data in global health and development, focuses on Zimbabwe as an example of the enormous progress that has been made against HIV/AIDS since those dark early days.

At the height of its epidemic in 1997, a shocking 1 in 4 adults in Zimbabwe — roughly 1.5 million people, about the size of the population of Philadelphia — were infected with HIV, the virus that causes AIDS. So the country made a dedicated push to say we’re not going to be victims of HIV; we’re going to invest in treatment and prevention. As a result, HIV infections are down 49 percent since 2010 and AIDS-related deaths are down by 45 percent. These achievements have done much to transform the country, despite political and economic turmoil.


The Goalkeepers report focused on Zimbabwe for another reason in addition to its success against HIV: More than half its population is aged 25 or younger, which means they’re entering the time of life when they are most at risk of infection with HIV.

Zimbabwe isn’t unique in this regard. Globally, the largest generation of young people in human history is approaching that vulnerable age — a trend that’s most prevalent in sub-Saharan Africa.


The good news is that this generation is the healthiest and most educated the continent has ever seen. No previous generation has been so well-equipped to build strong communities, drive economic growth in their countries, and expand the limits of human possibility.

With the right investments in health and education, these young people will lead a new wave of economic progress in sub-Saharan Africa that matches what we have witnessed in China starting in the 1990s and India in the 2000s.

The promise of progress is incredible, but it won’t happen if this generation is ravaged by HIV. And the stark reality is that we won’t prevent another crisis if we just keeping doing what we’re already doing. It won’t even be enough to expand our efforts with the methods and medicines currently available to prevent and treat HIV/AIDS, although that’s also an urgent priority.

The truth is, we must find new and better ways to dramatically accelerate progress on HIV/AIDS and start to turn ideas into solutions more quickly.

That demands aggressive, sustained investment in global health research and development into new methods for preventing HIV by governments, private enterprise, and philanthropic foundations like ours. These can take many forms. One is more effective and longer-lasting drugs, known as long-acting pre-exposure prophylaxis (PrEP), that can stop HIV from taking hold and spreading throughout the body. Another is exploring advances in immunology and the possibility that they can be trained against HIV. And then there is the medics’ holy grail: a vaccine.

It will take time before anything truly revolutionary becomes available. But at the Bill and Melinda Gates Foundation, we are confident that a new and better PrEP can be available in about five years’ time. And there are two large-scale clinical trials (called Uhambo and Imbokodo) underway to test potential HIV vaccine candidates.

Making such preventive measures extensively available could avert up to 364,000 new cases of HIV among 15- to 29-year-olds in Zimbabwe by 2050, according to data modeling carried out by a team from Imperial College London for the Goalkeepers report. That’s 364,000 more young Zimbabweans who can become leaders, activists, entrepreneurs, and innovators to carry the country forward.

The case is clear. If we keep doing the same things, the same way, we run the serious risk of a resurgent HIV/AIDS epidemic that will rob people in the world’s poorest places of the chance for long, healthy, productive lives — that’s the peril. The potential is that discovering, developing, and delivering more effective treatments and prevention methods for HIV/AIDS will unleash healthy, thriving young populations that will build healthy, thriving economies.

Sue Desmond-Hellmann, M.D., is the CEO of the Bill and Melinda Gates Foundation.

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