In a statement on HIV/AIDS, U.N. Secretary General Kofi Annan recently said, “For far too long, the world was in denial. But over the past 10 years, attitudes have changed. The world has started to take the fight against AIDS as seriously as it deserves.” Is this really the case? It is clear that the fight against AIDS is characterized by a long list of half-met promises, and the struggle, particularly to make AIDS a political priority, is far from won. Grasping the enormity of the AIDS epidemic and its appalling consequences remains daunting. Since 1981, when the first case of the virus was reported, 25 million people have died from AIDS. 40 million people are infected, with 24.7 million of those in Sub-Saharan Africa. An estimated 4.1 million people have become newly infected with HIV in the past year, and an estimated 2.8 million people have died. Another person is infected with HIV every 8 seconds. A recent United Nations report stated that HIV infection rate is rising in every region of the world.
While all industrial countries have taken steps to meet the UN goal of committing 0.7% of national income for the Millennium Development Goals, almost all are short of meeting it. All have pledged to support the Global Fund to fight AIDS, Tuberculosis and Malaria, with the goal of $9.5 billion by 2008; at present, only $5.9 billion has been raised. All have pledged to work as an “international community” with shared goals and approaches, yet anti-AIDS efforts continue to reflect each country’s particular ideology and priorities. President Bush’s AIDS plan, PEPFAR, which supports non-profit, non-government, and faith-based organizations in treatment, prevention and care programs, remains a prime example as it discounts the advice of AIDS experts around the world and instead continues to earmark much for the funding for abstinence-only education programs that often prohibit the distribution of condoms. Likewise, the goal of universal AIDS treatment by 2010 set by the G8 in 2005 seems doomed to fail, with current trends indicating that over 5 million people will remain without treatment.
In Africa, while many governments have implemented immediate treatment initiatives for the elite, there has been scant focus on prevention efforts or widespread treatment programs. In 2001, African governments pledged to allocate at least 15 percent of their national budgets to the health sector. Very few governments have actually done so. Several have allotted only 2 or 3 percent. Alex de Waal, director of Justice Africa, explains that “at the moment there's no reward to a government that cuts down the number of new HIV infections... if the incidence rate – new infections – begins to fall, it can take six or eight years before that registers in prevalence data. That time delay alone is enough to switch off any politician's interest.”
Certainly in the past 25 years there have been successes. Most impressive are the vast medical gains that have been made. Developments in anti-retroviral medication has rendered AIDS a chronic and treatable condition rather than an inevitable death sentence. Almost ubiquitous access to ARVs in developed counties is a mark of significant progress, and while access continues to be far too limited in the developing world, important steps to provide treatment continue to be made. Recently, the Clinton Foundation successfully negotiated with two pharmaceutical companies to cut the price of treatment for children with AIDS, allowing an additional 100,000 HIV positive children to receive treatment in 2007.
In the industrialized world as well as in Africa, combating AIDS is a matter of deploying concentrated political will. In 2005, in an act of bipartisan leadership, Senators Rick Santorum (R-PA) and Dick Durbin (D-IL) added an amendment to the 2006 Senate Budget Resolution, allocating a minimum of $800 million for the Global Fund for 2006, an additional $500 million to Bush’s proposed amount. In explanation, Santorum released a statement, saying, “ By passing this amendment, we show our bipartisan commitment of compassion to ensure that the effort to fight these diseases knows no political boundaries.” The resulting contribution from the U.S. is needed solely to continue existing efforts of the Global Fund; much more is needed if work is to be expanded. The upcoming year is critical, with PEPFAR up for reauthorization and a new congress coming into session. It is anticipated that congress will actively seek to undo some of the more harmful aspects of PEPFAR including the abstinence-only funding and anti-prostitution requirements and will extensively review the faith-based aspects of the President’s plan. Congresswoman Barbara Lee (D-CA) has already stated that she will offer legislation focused on allotting US funds for comprehensive prevention programs worldwide. Examples of political leaders taking bold steps to fight AIDS remain few and far between; hopefully leaders around the world can build on the existing successes and can begin to fulfill their promises.
Alexandra Kendall is a Research Assistant at The Century Foundation.
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