Whatever Happened to HIV/AIDS?
Posted by Heather Hurlburt
Today, the UN launches a five-year review of world efforts to fight HIV/AIDS. Yesterday, UNAIDS released a comprehensive report on the state of the epidemic. whether the glass is full or empty depends very much on whom you talk to. US Secretary General Kofi Annan, who said countries were "distressingly" short of their targets while the world was "unconscionably slow" in responding to the epidemic among women and girls, seemed not to be reading from the same talking points as UNAIDS head Peter Piot, who said:
Encouraging results in HIV prevention and treatment indicate a growing return on investments made in the AIDS response.
Confused? Haven't heard about AIDS in a while? Hoping you can take this one off the worry/guilt/policy priority list? Take my 2006 State-of-AIDS quiz and find out.
1. How much has spending on global AIDS risen since 2001?
2. What share of that is US spending?
3. How many people worldwide who have AIDS are now getting life-extending anti-retroviral therapy (ARVs)?
4. How much would it cost to get ARVs to everyone who needs them?
5. True or false: South Africa has more HIV-positive citizens than any other country.
6. Given the above, Americans should feel:
a) bored. AIDS is over; there are more important problems.
b) a warm feeling of gratitude to the Bush Administration.
1. Global spending on AIDS has risen fivefold, from $1.6 billion in 2001 to $8.3 billion in 2005, according to the new UNAIDS report. US spending on global AIDS will be four times as high as it was in 2001.
2. US spending this year will be about $3.4 billion by the calculations of DATA (Debt AIDS Trade Africa). So that is more than one-third of global totals. Of course, in 2001, US spending of $840 million was more than half the global total of $1.6 billion. The EU is the second-largest contributor, having spent $1.4 billion on AIDS, TB and malaria together from 2003-2006.
3. The number of people in low-income countries with access to anti-retroviral treatments for AIDS has more than quintupled since 2001, from 240,000 to 1.3 million. That's pretty impressive -- but 4.1 million people get AIDS every year, and somewhere around 38.6 million are living with the disease, meaning that only about one in thirty has the chance at life-exgtending treatment. Some countries, like Botswana, have made huge strides -- there, in an innovative partnership among big drug companies, the Gates Foundation, and aid agencies, 85 percent of AIDS patients get treatment. Elsewhere, though, the numbers remain minuscule.
4. This is why, at the bottom of UNAIDS' positive-sounding press release, there is this mind-bending number: $20 billion. That is how much it will cost per year, from 2008 on, to meet the goal of providing AIDS prevention, treatment and care for everyone who needs it. In other words, the US and EU would each have to more than triple current funding levels to get there.
5. The report contains the good news that the epidemic appears to be topping off in countries like Kenya and Zimbabwe (though I personally wonder about all statistics coming out of the country ruled so despotically by Robert Mugabe). But, as long predicted, India's rate of HIV infection is approaching 1 percent of the population, the point considered a generalized epidemic (and one the US never reached). India now has more HIV-positive citizens -- 5.2 million -- than any other country. Concern is still strong about India and (less so) China, and very strong about an injecting-drug-based AIDS epidemic sweeping Eastern Europe and the former Soviet Union.
6. Given the above, how should we feel? Public attention may have moved on, but it's important to underline, with AIDS resurgent among the poor and drug users in this country, and concern about other epidemic diseases rising globally, we are not out of the woods on AIDS.
The Bush Administration deserves (as Sebastian Mallaby wrote in the Washington Post on May 30) tremendous credit for pushing up its funding numbers enormously. The citizen campaigners and religious groups who turned around public and especially conservative Christian opinions on AIDS deserve even more credit. The progressives in Congress and among the advocacy community, who have fought to preserve frank sex education, condom and sex-worker-based policies deserve credit too.
And yet. The total numbers of people infected with AIDS are still rising, though death rates are falling. The human, economic and security consequences predicted back in 2001 are materializing: children raising children (read Nick Kristof's heart-rending columns on this), economic potential collapsing, armed forces imploding, AIDS-infecting rape used as a weapon of war in West and Central Africa.
That does not add up to success. It does not say much for how deeply we feel our common humaity. And, on a more pragmatic level, it does not send a very reassuring message about our ability to combat AIDS in "more strategic" regions of the world, or our ability to combat other epidemics as they arise.
The Bush Administration has requested another jump-up in AIDS funding this year, though not for the UN's Global Fund for AIDS, TB and Malaria, which is regrettable. But we need the funding and the global leadership, in one area where, all partisanship aside, the US is depended on for it. Because, as imperfect as our AIDS leadership has been, it is real (see #2 above). A month ago, I got into a conversation with some progressives who liked the idea that, because some Bush Administration policies are so dreadful, the world wouldn't really be any worse off if the Administration stopped funding the global AIDS fight. That's just wrong.
So call your members of Congress. Support an advocacy campaign. Tell someone you know that AIDS is still out there. and make sure progressives know you expect at least as much leadership from us.