"We cannot confuse progress with victory - this epidemic is far from over."
-- Helene Gayle, M.D., M.P.H. Director of the Center for Disease Control's National Center for HIV, STD, and TB Prevention
Living in North America, we often hear about HIV/AIDS and prevention. Many believe that because of medical advancements and education efforts AIDS is no longer an issue. However, that is simply not the case. HIV/AIDS rates worldwide remain astounding and despite our best efforts to achieve the goal of reducing the spread of HIV/AIDS the rate of infection is increasing..
Policy makers around the world are taking notice of the global importance of Africa and the rapid change taking place on the continent. However, Africa remains plagued by regional conflicts, genocide, poverty, famine, and an HIV/AIDS crisis of Biblical proportions.
According to UNAIDS:
• An estimated 33 million people are living with HIV/AIDS worldwide, while 25 million people have died of AIDS, almost two-thirds of them in sub-Saharan Africa;
• 96% of those living with HIV are in the developing world;
• Every day, 6,500 people die as a result of AIDS;
• Women are increasingly at risk of HIV infection and now make up 48% of HIV cases around the world and more than 58% in Sub-Saharan Africa;
• Young people ages 15 - 24 represent over 40% of all new HIV infection cases and 62% of infected young people are female;
• 2.3 million children under age 15 are currently living with HIV, 87% of whom are in Sub-Saharan Africa;
• Fewer than one in five people worldwide who are at risk of being infected by HIV have access to prevention programs, and only 20% of those in low and middle-income who need anti-retroviral drugs (ARV’s) have access to treatment.
On May 11, 1999, the World Health Organization announced that HIV/AIDS was the "world's most deadly infectious disease." On April 30, 2000, recognizing that the AIDS epidemic could "topple foreign governments, touch off ethnic wars and undo decades of work in building free-market democracies abroad," the Clinton Administration formally declared HIV a threat to national security. And in April 2003, Secretary of State Colin Powell said, "The greatest weapon of mass destruction today on the face of the earth is the HIV virus, and it is a destroyer of people, families, nations, societies and hopes in the poorest parts of the world, and it is spreading."
Since the beginning of the epidemic, AIDS has been responsible for the death of at least 25 million people, and has become the fourth leading cause of death worldwide. During 2005, approximately 4.1 million people became infected with HIV across the world; this was equivalent to: 11,200 new infections per day, 468 infections per hour, 8 infections per minute. Half of the people who acquire HIV become infected before they turn 25 and typically die of AIDS before their 35th birthday.
HIV/AIDS poses a grave threat to the future security and well-being of our world. With staggering infection rates across the world, AIDS is a disease that threatens to bring down entire nations if not immediately addressed. In the 21st century, one in four adults in numerous developing countries will have contracted HIV. Effective prevention programs and care initiatives require funding, yet the countries hit hardest by AIDS are among the poorest in the world. Just as we have made a commitment internationally to fight evil regimes wherever they may be, we should make a commitment to fight an evil virus that threatens the people of Africa and other developing regions of the world.
The nations of Africa, Central and Latin America, and most of Asia - collectively known as the Global South - face great challenges and offer real opportunities. Political, social, and economic upheaval are prevalent in many of these nations; at the same time, the populations of the global South and their emerging markets offer immense opportunities for economic growth, investment, and cultural contribution. The global South includes nearly 157 of a total of 184 recognized states in the world, and many have less developed or severely limited resources. Unfortunately, the people of these nations also bear the brunt of some of the greatest challenges facing the international community in the next millennium: poverty, environmental degradation, human and civil rights abuses, ethnic and regional conflicts, mass displacements of refugees, hunger, and disease. Forty-four million children worldwide are expected to be orphaned by 2010, largely due to AIDS. Less than 1% per cent of persons living with HIV/AIDS in the developing world have access to life-saving anti-retroviral (ARV) treatment. Business as usual will not halt this disease. The pandemic requires a massive scaling up of financial resources.
AIDS threatens the fabric and well-being of entire countries. The cost of the response required to halt societal disintegration increases as more people lose their ability to provide for themselves and ultimately perish.
Responses to Global HIV/AIDS
The Global Fund to Fight Aids, Tuberculosis & Malaria
The Global Fund was created in January 2002 following United Nations Secretary General Kofi Annan’s call for a private-public partnership to deal with the greatest killers in the world. The Global Fund is a grant making body. Countries submit their own proposals to the fund which then chooses to which ones it will provide money. The Fund is unique in its board composition, not only are there representatives of governments and private corporations, but there are non-governmental organizations represented as well. Furthermore, both the donor and the recipient nations are represented on the board.
As a partnership between governments, civil society, the private sector and affected communities, the Global Fund represents a new approach to international health financing. The Fund works in close collaboration with other bilateral and multilateral organizations, supporting their work through substantially increased funding. The Global Fund relies on local ownership and planning to ensure that new resources are directed to programs on the frontlines of this global effort. Its results-based approach to grant making – where grant awards are disbursed incrementally, based on measures of progress – is designed to ensure that funds are used efficiently to scale up proven interventions. Only 40% of applications ever make it past the Technical Review Panel that vets the applications. Furthermore, the Fund is highly efficient – the overhead costs for the Global Fund are approximately 5%, (compared to 9-14% for USAID – the agency most U.S. bilateral aid goes through).
With Global Fund resources, local programs approved in Rounds 1 and 2 will support an unprecedented scale-up of HIV treatment. Over five years, an estimated 500,000 people will begin receiving antiretroviral treatment, representing a tripling of current coverage in poor countries (including a six-fold increase in Africa). An expected 500,000 children orphaned by AIDS will receive support and an estimated two million people with infectious TB will be treated successfully using DOTS. Over this same period, the Global Fund will finance combination drug treatment for resistant malaria for almost 20 million people worldwide.
However, the Global Fund remains underfunded; the United States has committed to contributing roughly $200 million a year; the Fund projects it will need nearly $2.5 billion to extend existing programs by another three years.
President’s Emergency Plan For AIDS Relief (PEPFAR)
The Presidents Emergency Plan For AIDS Relief was a five-year $15 billion initiative to combat the global HIV/AIDS epidemic announced by President Bush in 2003. PEPFAR provides funding for three aspects of the AIDS epidemic:preventionof new transmissions,treatmentof current cases, andcarefor orphans whose parents died of AIDS; it has a special focus on 15 countries in Africa and the Caribbean. In fiscal year 2007, the United States appropriated $4.6 billion to PEPFAR.
In 2008, President Bush signed into law the Tom Lantos and Henry J. Hyde U.S. Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008, which reauthorized PEPFAR, the President’s Emergency Plan for AIDS Relief. New goals of PEPFAR included preventing 12 million new infections, treating 3 million people living with AIDS and caring for 12 million people, including 5 million orphans and vulnerable people. The bipartisan bill pledged $48 billion over five years for U.S. Global AIDS programs – triple the amount authorized in the initial bill. $34.5 billion of this amount will go specifically to fighting HIV/AIDS.
Pharmaceuticals and AIDS
The issue of access to pharmaceuticals has become increasingly visible – especially in light of the ongoing negotiations between World Trade Organization (WTO) Trade Representatives concerning intellectual property rights.
Over the last few years, controversy has raged over the way in which WTO patent rules, by raising prices, prevent millions of poor people from being able to afford life saving drugs. The WTO’s Intellectual Property Rights agreement requires all member nations to comply with international patents, allowing pharmaceutical companies to maintain a monopoly on the production of life-saving medications. However, in the countries where the AIDS crisis is most severe, people have barely enough money to feed their families and pay for basic health care and education. They cannot afford to pay inflated prices for life-saving drugs. Neither can their heavily indebted national governments. Developing countries and activist groups around the world have demanded that the WTO put public health before private patent rights.
In November 2001, in Doha, Qatar, WTO Ministers agreed in principle that WTO patent rules should not prevent countries from taking measures to protect public health or promoting access to medicines for all. Ministers also agreed to revise a loophole in the WTO patent rules. This anomaly allows developing countries to import cheaper generic medicines, but restricts producer countries from exporting them. This restriction limits poor people's access to affordable medicines, and denies generic industries the export markets they need to produce on a scale that would assure the lowest possible price. In December 2002, 143 of the 144 members of the WTO agreed to a plan that would allow nations to export generic versions of these drugs to poor countries – significantly increasing access to life-saving medication. The United States blocked the agreement in the name of protecting the profits of U.S. based pharmaceutical companies, advocating the misleading position that a decrease in profits from the third world would lead to reduced incentives to create new drugs.