The Keep the Promise march on Saturday in Durban, South Africa. The city is hosting the International AIDS Conference for the first time since 2000, when rates of infection were much higher in the coumtry.
South Africa has more people living with HIV-AIDS than any other country in the world, a staggering seven million.
But, in the past generation, it has gone from being the poster child for the pandemic's relentless and unstoppable devastation to a symbol of hope and living proof that HIV-AIDS can be slowed, and maybe even stopped.
In 2000, the last time Durban hosted the International AIDS Conference, there were 4.2 million infected in South Africa, and the rate was doubling every five years.
There were 80,000 babies a year being born with HIV-AIDS, thousands of new orphans weekly, virtually no one on treatment, other than those in research projects, and the government of Thabo Mbeki flirted with fringe groups who argued that AIDS didn't exist.
Today, as the country prepares to host the 2016 International AIDS Conference, which begins Monday in Durban, the overall number of infected is up, but the number of newly infected has slowed dramatically, from 800,000 a year to about 200,000.
The number of annual deaths has also plummeted, from 450,000 to fewer than 200,000. In the process, life expectancy, which had dipped below 50 (and to 28 in the hardest hit region, KwaZulu-Natal), climbed back up to 62.
Last year, only 5,000 babies were born with HIV-AIDS. Put another way, 1.5 per cent of babies are now born with the virus, down from 30 per cent a generation ago.
South Africa is home to the largest treatment program in the world, with 3.4 million taking antiretroviral therapies that keep the disease at bay and, just as importantly, greatly reduce the likelihood of infecting others. And the government of President Jacob Zuma has pledged "treatment for all" in the coming years.
"Things have changed considerably in South Africa, and not just in government," said Dr. Olive Shisana, CEO of the South African Human Sciences Research Council and co-chair of the conference.
She said there is a sense of hopefulness, but that there is no room for complacency.
The Durban conference in 2000 is widely viewed as the beginning of the treatment era, even the beginning of the end of AIDS.
Worldwide, 17 million of the 36.7 million people living with HIV-AIDS are being treated, in large part because drugs are now affordable in the developing world. In South Africa, for example, antiretrovirals cost about $10 a month, compared to about $1,500 a month in Canada.
The treatment-as-prevention approach – pioneered by the B.C. Centre for Excellence in HIV-AIDS – has had a dramatic impact. The number of new HIV infections has dropped by one-third, from 3.1 million a year to two million a year between 2000 and 2015.
The dark side of these mathematical calculations though is that while two million more HIV-infected patients are getting treatment each year, there are two million newly infected.
In other words, progress is stalled.
In addition, the newly infected are increasingly from marginalized populations like sex workers, intravenous drug users and young women and girls.
"If there is a resurgence in new HIV infections now, the epidemic will become impossible to control," said Michel Sidibé, executive director of the United Nations agency UNAIDS. "The world needs to take urgent and immediate action to close the prevention gap."
But, at a time when many countries are reeling from economic downturns and there are other political priorities, like fighting terrorism, international investments in HIV-AIDS are dropping from a peak of $9.7-billion (U.S) in 2013 to $8.1-billion last year.
Yet, the official policy of UNAIDS is that HIV transmission can be stopped by 2030.
That will require significant scientific progress – from a functional cure to a vaccine – and even more considerable political commitment.
As Dr. Shisana said, be it South Africa or the world: "We must kick up our game or risk backsliding."
André Picard