There’s a lot of talk at the moment about where global health will feature in the Post Millennium Development Goals (MDG) framework. All sorts of high-level consultations are being held and, as a result, a huge number of different health lobbies are vying for position to ensure that their areas of focus are included.

Maternal and child health, sexual and reproductive health, HIV and AIDS, malaria and TB are the areas which (rightly) received significant attention in the MDGs. Understandably, there is a strong movement to ensure that they are not forgotten as we move towards what is likely to be a more generic health outcome in the post MDG framework – namely the need to achieve universal health coverage. But other health lobbyists are emerging too. This reflects a new era where non-communicable diseases such as heart disease, cancers and mental health disorders are likely to pose as great a threat to global health as those issues currently reflected in the MDGs. And what about the need to address those critical social determinants of health such as gender inequality, the impact of climate change on health outcomes and the need for good governance of health systems?

In the UK, VSO will continue to input into the debate and monitor progress through our membership of two coalitions – Action for Global Health and the UK AIDS Consortium. We are broadly supportive of the move to adopt achieving universal health coverage as the way forward. VSO’s health-systems strengthening approach will compliment this. However, we also recognise that it’s important to ensure that the new framework establishes realistic, measurable and achievable outcomes while resolving potential tensions. We need to find some way of ensuring that we are able to respond to the full range of emerging global health challenges, while avoiding simply creating a new set of priorities at the expense of the old ones. Equally, any proposed health objectives within the new framework need to be accompanied by genuine global political will to ensure their successful delivery. A strong enough mechanism needs to be created out of the process that has the political clout to hold government, donors and civil society to account.

I must confess that as late as Sunday, as the International AIDS Conference (IAC) was opened officially, I kept on asking myself what would be new in this conference that people do not know already.  No, I am not a snob and neither can I say I know everything that is 'out there' on HIV and AIDS, but 30 years down the line, and it being so easy to share information online, one can be excused for wondering aloud!

Well, three days into the conference, it is a clear fact that the world has turned a new leaf on HIV and AIDS. Antiretrovirals (ARVs, the drug that controls HIV) are there for 'anybody' who needs them. Even for those people who have HIV but their partners are negative, new studies show that if both partners take ARVs, then the chances of the negative partner being infected are reduced by about 90%.

This is all very good news of course- except for a majority of people in Africa where the developments in diagnosis and treatment are yet to be enjoyed at such a huge scale. This is mainly because people discover their HIV status very late and those on ARVs are only a small fraction of those who need to be on treatment. So it is unthinkable for someone who is not infected to be put on treatment! The truth of the matter is, it can’t happen. Well, unless they buy the drugs for themselves. And how many can do that? The drugs are way out of reach for most people but thankfully governments supply them for free. But does the money for ARVs come governments or donor funds? And this introduces the next paradox; overreliance by governments on donors for ARV drugs.

It's also a paradox that even in the 'adult' stages of the disease, when everyone is expected to know about HIV and AIDS, newly infected people– especially in Africa– always outnumbers those newly put on treatment!  And the majority of those getting infected are young people and women. It's when the factors that contribute to this reality are dealt with, that the tide will truly turn for all.

But it is not all gloom at the IAC. Far from it. "Don’t criminalise HIV and AIDS" seems to be a very strong message that is coming out from the conference. So when the activists took to the streets of Washington on yesterday, this message was expressed in all its forms.

As you may have noticed, I haven’t mentioned caregivers. Sadly, it seems their tide is yet to change.

Yesterday I attended a session at the International AIDS Conference in Washington on building support and capacity for community based HIV and AIDS service delivery.

Distinguished researchers reported proudly how community health programmes across Africa and Asia were being delivered by dedicated community health volunteers in return for incentives such as t-shirts, training and transport costs. Due to the dedication of these community health volunteers, presenters from Nigeria, Ethiopia and Kenya were able to report improved community access and adherence to essential ARV [drugs used to supress the HIV virus] treatment, family planning, voluntary counselling and testing and a reduction in stigma and discrimination against people living with HIV and AIDS.

Working with community health volunteers was hailed as a cost effective approach. It all sounded wonderful...

However, I was proud to offer an intervention from the floor. I highlighted VSO’s commitment to supporting community health volunteers and home-based carers in a more holistic way. I stressed our  commitment to the principal that no volunteer should face the risk of further impoverishment as a result of their efforts to improve community health outcomes in high incidence HIV settings.

VSO promotes a complete package of interventions to support health and HIV and AIDS volunteer workers including the provision of volunteer stipends and access to income generating and livelihoods activities. We also support our partners to advocate for the development and implementation of national policy and social protection measures that enshrine the rights of volunteer health workers, whilst also recognising and adequately rewarding the essential work they do.

We need to ensure that our call to value health volunteers and home-based carers becomes even louder in future. Volunteers providing essential health and HIV and AIDS services for hard to reach rural communities depend on us to support them to raise their voice so that the cost to them of their courageous and unselfish contribution towards overcoming global health challenges – including HIV and AIDS – is not too high.