TWENTY-FIVE years ago the diagnosis of pneumonia in five young men in the US signalled the emergence of a new disease. Today we call it AIDS, and last weekend the UN general assembly reviewed progress in our fight against it. Delegates found some cause for optimism, but the task ahead is daunting.
The scale of the epidemic is huge. UNAIDS, the UN agency coordinating the fight, estimates that 38.6 million people are living with HIV. Last year, 4.1 million people acquired the virus and 2.8 million died because of it. The proportion of the world’s population with HIV does, however, appear to have peaked (see www.newscientist.com/channel/health/dn9244.html), and the number treated with antiretroviral drugs has risen from about 240,000 in 2001 to 1.3 million last year. Funding for anti-AIDS strategies is up from around $1.7 billion in 2001 to $8.3 billion over the same period.
But there is more to these figures than meets the eye. Population growth means that the absolute number of people with HIV continues to grow. UNAIDS had hoped to be treating 3 million people with antiretroviral drugs by the end of 2005, a target it has missed: indeed, only 1 in 5 people who need these drugs are receiving them. UNAIDS estimates that by 2010 the shortfall in funds to fight AIDS will be more than $8 billion.
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The biggest failure has been in preventing the spread of HIV. This has happened in large part because of the nature of the virus, which is spread by sex and by people injecting drugs – subjects that many governments are anxious to ignore. In country after country, the trend has been the same: denial, followed by discrimination against people with HIV and groups at high risk of infection, such as prostitutes, homosexual men, prisoners and injecting drug users.
This is too bad. Preventive measures such as providing condoms, sterile needles and education, especially about avoiding risky sexual behaviour, have been shown to save lives and money particularly when targeted at high-risk groups. Yet 25 years after the emergence of HIV, many governments still have not grasped this simple lesson. Half the 126 countries that reported to UNAIDS have policies that interfere with prevention, such as laws making homosexuality illegal. At the UN last weekend, delegates insisted on expunging words such as “sex workers” and “homosexuals” from the political declaration.
UNAIDS says that for the first time we have the means to turn the tide against HIV. For this to happen governments must get over their moral and cultural objections and see HIV for what it is: an unrelenting health problem. Every day they delay, another 11,000 people catch the virus, wrecking lives and making the world more dangerous for everyone.
