AIDS 2014 – Plenty of slogans & new science but not enough money

At the world’s biggest AIDS meeting this week in Australia, one long-time activist and attendee sees lots of slogans and important new research findings but not nearly enough money to make use of either the potential new tools or the rallying lingo.

A new drug, Truvada, has been shown effective at preventing HIV infection and recently was endorsed by the World Health Organization for use by those most at risk of infection. Despite some disappointing news about efforts to come up with a cure for AIDS, scientists point to other research fronts, though less sexy than a cure, where progress is being made on the search for a vaccine, on treatments for preventing disease and spread of HIV.

“This is one of the most exciting times in terms of HIV science, but one of the worst of times economically,” said Mitchell Warren, executive director of AVAC (AIDS Vaccine Advocacy Coalition, which despite the name works across all aspects of disease prevention), who spoke with Humanosphere by telephone from Melbourne where the International AIDS Society is holding its biannual meeting AIDS 2014.

At the last big AIDS confab, then-Secretary of State Hillary Clinton vowed to help create an AIDS-free generation. Others spoke optimistically about the ‘end of AIDS’ as if the world is now at a tipping point, as if we are poised to end the pandemic.

This year, these mantras are still being chanted – joined by new ones such as the celebrity-fueled declaration No One Left Behind or the new 90-90-90 goal, of getting 90 percent of the infected tested and diagnosed, with 90 percent of those infected put on treatment aimed at seeing 90 percent of those on the anti-HIV drugs reduce their viral loads and remain disease free.

“These are great goals but the question is if we are even on the road to succeeding with any of these goals,” said Warren, who has been an ardent and vocal advocate for expanding access to HIV/AIDS prevention for decades. People are talking about an AIDS-free generation by 2030, he noted, or reaching other ambitious milestones against AIDS at some point in the future.

Mitchell Warren
Mitchell Warren
AVAC

“I think we need to look at what’s going to happen in the next two years,” Warren said. “People are talking about ending the AIDS epidemic and yet, at the same time, we’re not putting up anywhere near the resources or dollars needed to do this. In fact, we’re seeing less money available for this now.”

A report from the Kaiser Family Foundation and UNAIDS issued to coincide with the meeting reported a decline in government funding commitments during 2013 to sustain the global fight against HIV-AIDS in low- and middle-income countries – a total of US$8.1 billion in new funding, down 3 percent from 2012.

The report did note that actual dollar disbursements to fight AIDS increased by 8 percent in 2013 (from 2012) but the researchers said this was due to accelerated payments of prior-year commitments by the U.S. government (which remains the largest donor in the global fight against AIDS).

Kaiser AIDS funding
Kaiser Family Foundation

“Ending the AIDS epidemic will only be possible if donors and countries most affected by HIV remain steadfast in scaling-up funding over the long term,” said Luiz Loures, Deputy Executive Director, UNAIDS.

The international community’s response to the AIDS pandemic and the needs of poor communities overseas has been remarkably successful over the past 15 years of what, until recently, had been a trend of increasing investments in matters of global health. As one gang of Seattle researchers reported this week, the number of people living with HIV infection – and the number of people dying from AIDS, TB and malaria – have declined even more than earlier estimated.

Yet the number of people who are today infected with HIV and, lacking access to treatment, who are dying from AIDS (despite the simple fact that drugs exist to prevent nearly all these deaths) remain in the tens of millions. In fact, most people with HIV today – whether 35 million or the Seattle gang’s estimate of closer to 30 million – do not have access to treatment. Still.

And yet funding for this fight is on the wane, apparently.

“As Kaiser and UNAIDS reported, this is the biggest funding decline we have seen in years,” Warren said.

He noted that one of the popular slogans of the Obama Administration and other Western government leaders anxious to make the case for flat or declining donations to poor countries is that they want to see more ‘country ownership’ in the fight against AIDS (or the other diseases of poverty). It’s not always clear what this slogan means, but in general it translates into asking poor countries to pick up more of the health tab.

“That’s fine and it’s something we can encourage long term, but it’s not realistic in the short term in many instances,” Warren said. “It’s not something that’s going to happen overnight.”

Without substantially increased funding and long-term commitments to continue the progress made over the last 15 years against AIDS, he said, none of the slogans and few of the scientific discoveries being celebrated this week down under at AIDS 2014 will get us any closer to seeing the end of AIDS.

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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.