Adeeba Kamarulzaman, President, International Aids Society: NCDs (non-communicable diseases such as cardiovascular diseases, cancer, mental health, addiction, etc.) make up a large and increasing part of the disease burden. Diabetes, for example, is now responsible for more deaths in South Africa than HIV. The recommendations launched at AIDS 2022 for policymakers, administrators and donors highlight the principles that need to be taken into account.

Katie Dain, Director, NCD alliance: The central problem is the fragmentation and lack of coordination of care: A diabetes clinic there, then to an HIV specialist and the day after that psychosocial counseling. Such highly specialized care structures do not think from the perspective of those affected. They are inefficient and more expensive.

Meg Doherty, Director Global HIV, Hepatitis and STI Programs, WHO: The focus is on the disease and not on health, on medical treatment and not on adequate healthcare. This also applies to prevention, such as preventive screening for cervical cancer instead of just isolated testing for HIV. However, the experience of HIV care in particular shows that decentralized and demedicalized models are possible if healthcare professionals are adequately and broadly trained. Doctors and a high level of specialization are not always needed for the basic care of HIV and NCDs. An integrated service is more cost-effective and makes it possible to provide holistic care by and for communities in many places instead of many highly specialized centers for diabetes, HIV, cancer, addiction and more.

Kaushik Ramaiya, doctor, Tanzania: But how do we decide which NCDs are relevant? It is impossible to integrate everything. The decision should be based on the specific disease burden in the community and then, just like HIV, be organized systematically and consistently from prevention to treatment.