Recently, Foreign Policy published “The Long Emergency,” an analysis of the future of the United States’ HIV/AIDS programming and funding as the Obama administration reshapes its global health agenda. The photograph accompanying the article is uncaptioned but it depicts young people, presumably Africans, holding up Obama posters that say “Stop AIDS, TB & malaria. We’re halfway there. Don’t be half-hearted. Yes we can.” A reflection of the power of hope that President Obama built his campaign around perhaps, but the reality is we’re not even close to halfway.

Yes, we have succeeded in providing antiretroviral therapy to 4 million people; more than half of this has been accomplished through the President’s Emergency Plan for AIDS Relief (PEPFAR). Jumpstarting treatment is considered by many to be the crowning achievement of PEPFAR, a political breakthrough that ‘forged overwhelming consensus of support’ by focusing on treatment so as to avoid ‘political flashpoints’ like condom use and abortion. Politically savvy though it might have been, PEPFAR also created a false dichotomy between HIV prevention and treatment. Some argue that treatment is prevention because it curbs a person’s infectivity, because it prevents vertical HIV transmission, or because it is effective in post-exposure prophylaxis. That’s all true. But it isn’t the preventive nature of ARVs that makes the dichotomy false, it’s the reality that studies from some African countries suggest that in as many as two-thirds of couples where one partner is living with HIV, the other partner is HIV-negative. This means within one household, one marriage, one family, people need treatment and prevention. Either, or is not an option; communities need both.

Yet, today, nearly 10 million people living with HIV will go without the antiretroviral (ARVs) therapy they need to lead healthy and productive lives. For every two people we put on ARVs, five more are newly infected. This adds up to 7,400 new infections every day.

I often hear about the need for success stories, but sometimes we must also look at cold, hard facts and demand more of our leaders and of ourselves. That time is now: this month, global health leaders and activists will meet at the International AIDS Conference, AIDS 2010, in Vienna. This conference is one, of many, that builds on earlier work, including the 2005 commitment by the Group of 8 (G8) nations to provide all people with universal access to HIV prevention, treatment, and care. This rallying cry was taken up at the 2005 United Nations Millennium Summit and crystallized in the 2006 Political Declaration on HIV/AIDS. We have not yet realized these promises.

As we take stock of the global HIV/AIDS response’s successes and failures, we need to set new goals for this work that are both ambitious and realistic but also situated firmly within the larger global health agenda. We need to realize these are people’s lives we’re talking about so it’s not question of yes, we can. It’s yes, we have to.