Health Alliance International

World AIDS Day: Great Promise If We Keep Our Promises

Posted: Dec 01, 2010 · Posted by: Emily deRiel, Communications and Policy Manager

World AIDS Day is always an occasion to reflect on successes in fighting AIDS, and renew our resolve to continue working toward and AIDS-free world.

This year these reflections seem particularly urgent.

There have been several important advances this year in HIV treatment and prevention, including a trial of a tenofovir-containing microbicide that resulted in a 39% reduction in the risk of HIV infection in women. The New England Journal of Medicine just published a study that found that HIV-negative men who have sex with men reduced their risk of HIV infection by 44% by taking a daily dose of two oral HIV drugs (a practice called pre-exposure prophylaxis). Those who adhered most closely to the regimen were up to 90% less likely to contract HIV.

But hope lies not just in new technologies or therapies. Global health leaders -- including ministries of health and programs like the U.S. Global Health Initiative (see the Kaiser Family Foundation's excellent resources) -- are also increasingly focusing on health systems strengthening and integration of health services as a way to build governments' capacities to curb the epidemic while also improving other health outcomes. Last month also marked the first global symposium on health systems research in Switzerland, intended to advance the ways that health managers can measure the effects of health systems strengthening initiatives, and identify areas for additional work.

It is important to acknowledge this increasing emphasis on health systems and country ownership of these systems, since the theme of World AIDS Day this year is "universal access and human rights."

Public health systems are key to making effective and affordable care -- both preventive services as well as treatment -- available to all. Today, more than 5 million people receive antiretroviral treatment for AIDS, while about 33 million are HIV-positive. According to UNAIDS' 2010 Global Report, in twenty-two countries in sub-Saharan Africa HIV incidence has declined by 25%, although in other countries (particularly eastern Europe and central Asia) new infections have increased. More people are being tested for HIV, and more people have access to treatment than ever before, but efforts need to be scaled up even further.

HIV testing in Côte d'Ivoire (Photo: HAI/S. Gloyd)

Despite this growing awareness -- and here's the urgent part -- funding for global health efforts, including HIV/AIDS, has stagnated and may even be cut.

PEPFAR funding has been flatlined for 2011, and donor countries pledged only $11.5 billion to the Global Fund for AIDS, TB and Malaria -- more than $1 billion short of the minimum amount that Global Fund director Michel Kazatchkine said was necessary to sustain current programs for the 2011-2013 period.

Some writers and thought leaders have questioned whether the U.S. funding for HIV/AIDS is wise. Elizabeth Dickinson noted the tension between funding AIDS treatment -- the need for which is constantly expanding and is a lifetime commitment -- and funding other health priorities. Princeton Lyman and Stephen Wittels posited that the U.S. commitment to AIDS funding decreases our foreign policy leverage and undermines other development goals.

But Mark Dybul and Michael Gerson write today about why AIDS was and is a priority:

"HIV was not just another disease to be coldly calculated by cost per life saved. It was taking the people, and undermining the attitudes, that make modern society possible. Early in this decade, Africa had many other needs, but the threat of this disease was overwhelming. Issues such as health infrastructure are important -- but they become less urgent during the Black Death. It was necessary, even unavoidable, to put AIDS first."

So health workers, advocates and patients continue to call for the U.S. and other countries to give the funds they promised for HIV/AIDS. Knowledge about HIV is spreading, including the knowledge that it is not a death sentence and there are ways to live responsibly with HIV. Now, when there is so much positive momentum, we can't afford to reduce programs, turn people away from treatment, and return to the days of hopelessness and fear.

On this World AIDS Day, let's remember the millions of lives that hang in the balance, and the voices that inspire us to keep working toward an end to AIDS, not just today, but all year round.

Health workers and women at a maternity waiting home in Mozambique (Photo: HAI/W. Johnson)