Another World AIDS Day comes round, and while the main players can’t seem to decide what the theme is for 2011 (“be an activist” according to UNAIDS; “getting to zero” according to the World AIDS Campaign; “leading with science, uniting for action” according to the US government), it is clear that there are two issues that are dominating all of the current discussions about the fight against the pandemic: the major advances in the technologies used to fight HIV transmission, and the abrupt and significant decrease in the funding being made available to pay for them.
Secretaty Clinton talked, a few weeks ago, about the US government’s commitment to a “combination” approach to HIV prevention based on proven technologies to prevent mother-to-child transmission, on male circumcision, and on making the most of the now-proven fact that putting people on treatment significantly reduces the chances they will transmit the virus onwards. In her speech she stated that creating an AIDS-free generation was now official US policy.
More recently still the Global Fund to fight AIDS, TB and Malaria, set up only ten years ago to channel funding to efforts to fight these three diseases, announced that because most of its donors have failed to commit enough funding, and indeed because many haven’t even paid what they promised, it is suspending funding for new grants and proposing a new model which will take account of the reduction in funds available.
Much of the commentary on World AIDS Day 2011 is likely to focus on the disconnect between the optimism of knowing “what works” and the failure of donor governments to keep their promises. I think this article from the Instute of Development Studies sums up the ambivalence very well. But it also talks about some of the other challenges: the challenges of implementation.
I’ve been trying to sum up how I think my year as a freelancer working to support AIDS programmes has gone. Earlier today I sent a few tweets:
(“men who have sex with men” – actually, he identified as gay but its hard to explain this in 140 characters)
I wasn’t going to say anything else, but then it occurred to me that, with the exception of the last one, none of these issues has much to do with either the lack of money or the existence of new technologies. These problems were happening irrespective of whether men have foreskins or not, and irrespective of the preventive effect of ARV treatment. Madagascar has plenty of money for ARVs and only has to keep a few hundred people on treatment, and yet there are failures when it comes to stigmatised populations. Benin is a small country, with reasonable grants for HIV treatment, but somehow many people with HIV still face problems getting their drugs regularly. The situation faced by sex workers in Namibia is faced by sex workers around the world. Despite explaining how badly they get treated by health care workers, or how often they get beaten up and extorted by cops, the default mode for HIV programmes seems to be to give them leaflets and condoms.
As for the last tweet… well, that is about the money, and about what happens when big institutions end up searching high and low for ways of justifying their existence.
As we move into the fourth decade of the fight against HIV and AIDS, promoting the amazing new tools at our disposal and demanding the funds to pay for them, I hope we won’t lose sight of the fact that there’s an awful lot of other stuff the AIDS response needs to start fixing and doing better if the technology and the money is going to make a difference.