How the war on AIDS was lost

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There was an alarming article in the Wall Street Journal on the reverses of previous advances in AIDS prevention in Uganda, plus running out of US funding for AIDS treatment. The war on AIDS is being lost. Here are the facts:

  1. There were an estimated 2.7 million new infections worldwide in 2008; 1.9 million of them were in Sub-Saharan Africa.  The number of people added to treatment each year is also increasing rapidly, but not rapidly enough to keep up with new infections. Worldwide in 2008, 1.1 million people were added to treatment; 825,000 of them in Sub-Saharan Africa.
  2. New global funding for AIDS has grown rapidly over the past decade, but funding from the US government for major programs  PEPFAR and the Global Fund (a large portion of total AIDS funding)  now appears to be leveling off.

Despite the goal of “universal access to treatment” (a Millennium Development target that was supposed to be met by 2010),  only 44% of people in need of ARV treatment in Sub-Saharan Africa were actually receiving it. Now, as the WSJ story and other reports document, sick people are being turned away without treatment, and many who contract HIV in the future will have no hope of treatment.

Last year the WHO country representative in South Africa warned that "At the rate we are going, with new [HIV] infections rising it will be almost impossible ... to keep providing free treatment to those who need it."

How did this enormous tragedy occur? Perhaps because the global health community concentrated on AIDS treatment and neglected prevention (which they never figured out how to do). As was pointed out by David Roodman in Monday’s blog post, public attention and activism is a finite resource. In AIDS, virtually all of it was spent on treatment (led by the 3 Bs - Bono, Bill Clinton, and Bill Gates - and 1 W) and very little on prevention.

Despite AIDS  getting unprecedented amounts of funding, funding was never going to be unlimited.   So there was going to a treatment funding crisis sooner or later, as Mead Over recently pointed out.

This current crisis was anticipated by writers like Helen Epstein, Daniel Halperin, David Canning, and Over. All have issued pleas for emphasizing AIDS prevention and given practical advice on doing prevention. All have been ignored.

Will there at last be a new war on AIDS that emphasizes prevention, that saves the next generation?