Without more money, it’s the end of the beginning of the end of AIDS

Tomorrow is World AIDS Day and most organizations that had something to say about this have already said it.

Most said: “We can end AIDS.”

Secretary of State Hillary Clinton
Flickr, by Roger H. Goun

Secretary of State Hillary Clinton called for creating an “AIDS-free generation” and on Thursday released the Obama Administration’s blueprint aimed at describing how we can achieve this. Unfortunately, as the Washington Post noted:

The document, however, contains no specific targets or a schedule for achieving them. It also doesn’t estimate how much more money it would cost to reach the “tipping point” in high-prevalence countries, or where the money would come from.

Michele Sidibé, head of UNAIDS (the UN’s program on HIV/AIDS), also released a report and a suggested game plan for ending the AIDS pandemic.

The UNAIDS report celebrated major gains in reducing new HIV infections in many countries, some of them in sub-Saharan Africa, and called for “Getting to Zero” in terms of new HIV infections worldwide. Most of these gains have been in preventing mother-to-child transmission of HIV in newborns.

Michel Sidibé

“It is becoming evident that achieving zero new HIV infections in children is possible,” said Sidibé. “I am excited that far fewer babies are being born with HIV. We are moving from despair to hope.”

Others celebrated some of the scientific gains such as more conclusive evidence that getting people on anti-HIV treatment also prevents the spread of disease by significantly reducing viral loads in HIV-infected persons.

And though a vaccine still seems a distant hope, researchers have made progress and are making headway on the basic immunology in ways that have recently also moved the vaccine community from despair to hope.

A Positive Trend, new HIV infections vs people getting treatment to prevent AIDS

We can end AIDS. It’s true.

It is also true to say we can end hunger and extreme poverty, if only we put enough resources, talent and political will into those efforts. But we don’t.

And until we put in the effort needed to truly suppress HIV/AIDS, calling for an end to the global AIDS pandemic will be, despite some amazing progress made in the past decade, wishful thinking.

The basics: About 34 million people are HIV-infected, some 7 million of them in need of treatment right now. Many will pass on their infection to others and many will die without treatment.  Experts estimate that from 2.5 to 3 million people got newly infected last year.

So, no, we’re not even close to ending AIDS. Just repeating this mantra — as was done earlier this year at the 2012 International AIDS Conference — doesn’t make it true. Bill Gates appears to agree with me that this kind of messaging might even be harmful, since this still looks to be a long battle.

To its credit, that was the basic message of the ONE Campaign’s report The Beginning of the End? The question mark alone signifies how ONE’s tack differed significantly from the more optimistic rhetoric of the Obama Administration and UNAIDS:

(W)e are mindful that words alone are insufficient for enacting real change. In the lead up to World AIDS Day 2012, then, ONE has prepared a new accountability report to monitor progress made towards the beginning of the end of AIDS…. Much progress has been made across these three targets, and many stakeholders are making significant contributions to the fight against AIDS.  But ultimately, the report finds that without a heightened sense of urgency and without collective action starting in 2013, the beginning of the end of AIDS will remain a distant ambition, and millions of lives will hang in the balance.

The world is off-track in its battle against the AIDS pandemic, ONE concluded, and we are now at risk of losing some hard-won turf against this disease which continues to spread, kill and undermine the future of millions of people worldwide. Just more of the same level of effort against AIDS, ONE says, means we will lose ground.

Michael Elliott

Michael Elliott, chief executive of ONE, said, “We recognize the world has done wonders in fighting AIDS in the last 10 years. But 2015 is just around the corner. Here’s a moment to put your pedal to the metal and go for it.”

ONE lays out specific actions needed, beginning with an increased level of global funding of at least $6 billion (some say more like $7 billion is needed) in support of efforts such as that led by the Global Fund to Fight AIDS, TB and Malaria and the U.S. government’s’ Pepfar program (home of the Obama blueprint). More money should go into expanding treatment and prevention of mother-to-child infections, ONE recommended.

Similarly, the AIDS Vaccine Advocacy Coalition (which promotes many aspects of AIDS policy beyond just the search for an effective vaccine), sounded the alarm and the need for stepped-up funding for treatment, prevention and research in a report called Achieving the End.

Mitchell Warren

“Recent scientific breakthroughs give us reason to be optimistic like never before, but our chances of success are already imperiled,” said Mitchell Warren, AVAC executive director. “Right now, the world isn’t moving as fast as it should be to begin ending the epidemic. There is still time to get back on a winning pace but only with focused, aggressive action now.”

AVAC calls for an end to the confused debate over best practices on prevention, for expanding access to treatment and to new prevention strategies and to continue to fund research looking for new weapons in this ongoing battle.

Amanda Glassman, at the Center for Global Development, also emphasizes that we have not yet even reached the beginning of the end. Glassman reviews all of the reports and recommendations and concludes:

Amanda Glassman

Of course, all of this is largely contingent upon one input: Money. The ONE report shows how much  bilateral and multilateral donors have committed thus far to the fight against AIDS, and concludes that all must ramp up their spending until 2015 – surely a tough message to convey in today’s fiscal climate.

Here in the U.S., it’s all about our fiscal cliff – with the rhetoric hysterically making many of us feel like the politicians are literally threatening to push us off a cliff. When it comes to the AIDS pandemic, the threat of funding cuts is a literal death sentence, and has already started to take its toll.

The scare tactics of old when it comes to AIDS, as The Guardian notes, just don’t work anymore.

But trying to flip it around and say, like your parents used to on those long road trips, that the end is just around the corner is perhaps even more misleading. We aren’t close to ending AIDS. This is going to be a marathon run and we need to step up the pace a bit, if only to avoid some deadly slippage.

Hard choices have to be made to avoid the end of the beginning of the end of AIDS.



About Author

Tom Paulson

Tom Paulson is founder and lead journalist at Humanosphere. Prior to operating this online news site, he reported on science,  medicine, health policy, aid and development for the Seattle Post-Intelligencer. Contact him at tom[at]humanosphere.org or follow him on Twitter @tompaulson.