More than 2 million additional people will contract HIV if the international goal to raise $26 billion by 2020 to stop the spread of AIDS is delayed by even five years, and 1 million more will die from it in the coming 12 years.
That’s the latest assessment from UNAIDS, the United Nations program on AIDS and HIV and one of the leading international agencies tasked with mitigating the virus. The organization now faces a precarious situation: Countries around the world have all benefited from an unprecedented international effort to stabilize the spread of HIV and AIDS, treat those who are infected and prevent future instances.
Those efforts, beginning in the early 1990s, yielded historic success and since 2006 have accounted for a steady drop in global AIDS-related deaths as an increasing number of people receive services and many can now live with HIV.
Yet those achievements have also led to an air of complacency, scientists and public health leaders say, made worse by some Western countries’ controlling the domestic spread of HIV and AIDS. The successes preceded, for example, U.S. President Donald Trump‘s proposed reduction in investment in groundbreaking organizations fighting AIDS such as PEPFAR, an invention of the George W. Bush administration that currently supports more than 14 million men, women and children around the world. Trump also reportedly closed down the White House’s Office of National AIDS Policy in January 2017, formed during President Bill Clinton’s administration to coordinate U.S. efforts to fight HIV and AIDS.
Those factors contribute to the current 20 percent shortfall in the United Nations’ 2020 goal, with no indication that new sources of funding will materialize soon. As the 22nd International AIDS conference begins on Monday in the Netherlands, experts worry that the effect will be felt worldwide.
“There is a very real, good news story to tell. And there is a very real bad news story to tell. By telling them both in the same breath, I fear we may have negated them both,” says Jenny Ottenhoff, policy director for global health at The ONE Campaign, a nonprofit organization co-founded by U2 frontman Bono and dedicated to fighting poverty and preventable afflictions such as AIDS in Africa. “What we’ve seen in the last five years is progress is still continuing at a steady pace, and there’s still steady international support, but there are signs of increasing complacency and really a lack of urgency to address the problem.”
While AIDS-related deaths have declined since the late 1990s in most places, there are troubling trends elsewhere. Eastern Europe and Central Asia, for example, saw steady growth in AIDS-related deaths from 1998 to 2015, due in part to societal stigmas there, like elsewhere, against drug users, sex workers and same-gender sex — among the main factors that lead to contracting HIV and hinder access to services.
Further worrying international observers is the annual incidence of newly infected people, which has remained steady in recent years at roughly 1.8 million people per year.
“We are sounding the alarm,” Michel Sidibe, UNAIDS executive director, said in a statement. “Entire regions are falling behind, the huge gains we made for children are not being sustained, women are still most affected, resources are still not matching political commitments and key populations continue to be ignored. All these elements are halting progress and urgently need to be addressed head-on.”
Recent trends, such as shared needle use amid the ongoing opioid crisis in the U.S., threaten to further undercut gains during the past two decades. Other indicators are already beginning to fall behind, like the transmission of AIDS from a mother to unborn babies, a trend that has increased in the past few years.
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“The challenge with that is if you let off the gas at all, we’re going to move in reverse. Extremely fast,” Ottenhoff says.
In many respects, HIV and AIDS has fallen from public attention in Western countries, particularly amid reports of newer and more immediately deadly threats such as Ebola. That virus, which swept across West Africa and reached the U.S., caused widespread panic and accounted for of 11,000 deaths during its two-year span — a relatively small number in comparison to the 1 million AIDS-related deaths per year.
The solution does not necessarily require new science, but rather surgically targeting disaffected communities, says Dr. Carlos del Rio, chairperson of the PEPFAR Scientific Advisory Board. He recalls a conversation with Dr. Jonathan Mann, the former administrator of the World Health Organization and a leading AIDS researcher who died in a plane crash in 1998.
“He told me, ‘If you want to find HIV in a community, find the most stigmatized and the most discriminated populations. That’s where HIV is going to be.’ This really requires a social solution,” says del Rio, also a chairperson of global health at Emory University’s Rollins School of Public Health.
The Trump administration proposed in 2017 to cut more than $2 billion in global AIDS spending, and limiting the number of new patients receiving PEPFAR care in relatively wealthy countries such as Nigeria and South Africa that are searching for new strategies to find funding to help solve the problem.
And that’s not entirely without merit, del Rio says. The program was designed to serve as a support mechanism, not charity, and countries such as Nigeria with vast oil wealth should take on more of the burden of supporting its own citizens. The South African city of Durban has more people on antiretroviral therapy than the entire U.S., he says.
However, the U.S. should continue its support for the program, del Rio adds, even if it is only interested in serving its own citizens.
AIDS is a relatively unique problem in that it strikes people at a disproportionately young age, usually when they are having sex or taking drugs. If the hardest-hit countries lose their young men, for example, they also lose their ability to secure borders and protect themselves. Keeping people healthy is a good way to pre-empt young people from turning to terrorism, he adds, and keeping people alive creates a new generation of consumers of international goods.
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“When we invest in programs like PEPFAR, we’re actually helping ourselves. We’re helping the image of the U.S., we’re helping to open markets for the U.S., we’re helping to ensure the security of the United States,” del Rio says.
It is essential to build on the successes of the past two decades, Ottenhoff says.
“Honestly, it’s simple math. There are going to be more infections among a more vulnerable population and we’re not going to be able to keep pace.”
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Complacency Is Greatest Threat to Fighting AIDS, Experts Warn originally appeared on usnews.com
