There is no question that as this decade ends, significant progress can be seen in the battle against HIV/AIDS.
There’s vastly greater awareness and there’s more money; in the developed world AIDS has been transformed into a chronic disease and the hospital wards of the developing world are no longer fast-tracked to the cemetery.
It’s not that death is on vacation. Two million people died of AIDS-related illnesses last year, and AIDS is the primary cause of death among women, world-wide, in their reproductive years. Prevalence rates remain staggeringly high in a number of African countries, and from Washington, D.C., to the First Nations reserves in Canada, the grim reaper still haunts the landscape.
But progress there has been. I wouldn’t dispute it for a moment. However, as we enter the new decade, it’s fundamentally shocking to realize how far we have yet to go.
While there are now four million people in treatment, there are an additional six million people who require treatment today, immediately, and we’ll never be able to roll out the drugs quickly enough to get to them all in time to keep them alive.
For every two people we put into treatment, there are five new infections. Clearly, despite herculean efforts, we haven’t found the key to prevention — all we can claim are snippets of behaviour change here and there among various age groups in various countries.
In the vexing area of vertical transmission — transmission from an HIV-positive mother to child during the birthing process — progress is sabotaged by inaccurate statistical data coming from UN agencies, and even more severely compromised by a double standard of treatment between North and South. You can guess who reaps the benefit.
We have no vaccine, despite heroic efforts to discover one, nor do we have a microbicide. An excellent preventive technology such as male circumcision is only now haltingly in use because of the endless delays and prevarications to which UN agencies are addicted. They take forever to make up their minds when the obvious stares them in the face. One of the things that most vividly characterized the last decade was a corrosive absence of multilateral leadership.
There’s a desperate shortage of doctors, nurses, pharmacists and community health workers. The opportunity to export generic antiretroviral drugs from developed countries has gone nowhere — only Canada made the effort and with both Liberal and Conservative governments, that effort is on life support.
The high-risk groups of men who have sex with men, sex workers and injecting drug users are only beginning to get the attention they deserve. But the intolerance and punitive hatred directed at so-called vulnerable populations makes progress very difficult.
Sadly, we have monumental numbers of orphans languishing without adequate attention and nurture in country after country. If it wasn’t for the grandmothers of the world, God knows what would happen to the majority of these children (which, forgive the shameless self-promotion, is why the Grandmothers to Grandmothers campaign of the Stephen Lewis Foundation makes such sense).
And to top everything off, because of pervasive, unrelenting gender inequality, women are disproportionately vulnerable. The response to women infected by the virus has been the most disappointingly lamentable of all.
The year 2010 was supposed to be the year of “Universal Access” to treatment, prevention and care. We’ve missed by a huge margin. That’s why it’s tough to be sanguine about what the next decade will hold.
But the real and most formidable challenge is that of resources. We’re billions of dollars short of what we’ll need, year after year to keep millions of people alive, and to fight the virus on many fronts.
And surprisingly enough, the problem of dollars lies primarily with the Obama regime. Who would have thought it? On two counts, the Obama administration has put the entire struggle against the AIDS pandemic in peril; both involve money. It doesn’t augur well for the next decade.
First, President Barack Obama has flat-lined the budget for PEPFAR, the President’s Emergency Plan for AIDS Relief. This is a direct reversal of the increases he promised during the election campaign, and the policy reversal is in place despite the fact that the increases have been endorsed by Congress. The AIDS activist community is rightly up in arms, given the astronomic amounts spent on bail-outs and bonuses. It’s hard to be persuaded that the financial crisis is so great as to prejudice an additional three or four billion dollars a year for HIV/AIDS when hundreds of billions are tossed around in wanton corporate fashion.
Second, and even more ominous, the Obama administration seems to have bought into the idea that AIDS has been receiving too much money at the expense of other global health priorities.
This is a truly pernicious argument. It leads to the intellectual folly of suggesting that resources should actually be taken away from AIDS and transferred elsewhere — say, to maternal and child health for example. It’s just so nonsensical that it’s hard to take seriously, except that some self-aggrandizing academics, salivating in the publicity, have put it forward as a thesis and won the uncritical approval of some members of the Obama coterie.
It’s hard to imagine that Barack Obama would fall for that kind of guff. The answer of course is to enlarge the pie for global health so that HIV/AIDS, still struggling as the world’s most alarming communicable disease, isn’t compromised.
That’s the challenge for the coming decade.
What is lacking in all of this is global political leadership. Only Gordon Brown, Prime Minister of the United Kingdom, of all the G8/G20 leaders, has thus far shown an abiding and determined commitment to ridding the world of poverty, conflict and disease.
Certainly Canada’s Stephen Harper isn’t in that league.
Stephen Lewis is former UN special envoy for HIV/AIDS in Africa.
– – –
The End of the 00s: A decade in review
The Citizen has asked prominent writers to assess human progress in a variety of fields over the last 10 years: economics, science and technology, culture, poverty alleviation, nuclear disarmament and more. Their responses will be run over the month of December.
© Copyright (c) The Ottawa Citizen