Sunday 22 Jul 2018 | 18:56 | SYDNEY
Sunday 22 Jul 2018 | 18:56 | SYDNEY

HIV/AIDS: The endemic problem


Bill Bowtell

3 December 2009 09:26

This piece was originally published on ABC Unleashed.

Over 25 years since the emergence of the HIV/AIDS virus, some 25 million people have perished from AIDS. The global caseload of HIV cases is approaching 35 million.

In 2008 alone, the rolling holocaust of the pandemic claimed another 2 million people and 2.7 million were newly infected with HIV. The lives of tens of millions of people, their families and communities have been blighted by the disease.

Unsustainable financial and logistical burdens have been imposed upon the health systems and budgets of weak and fragile states, including those of our nearest neighbours Papua New Guinea and Timor Leste. While the developed world, apart from the US, acted swiftly and effectively to contain HIV infection rates, the pandemic is continuing to advance in many parts of central Africa, Latin America and some parts of Asia.

Even in Australia, where our initial response to HIV/AIDS was bold, radical and right, the number of new cases of HIV infection has increased at an unacceptably high rate over the past four years or so. So the situation we confront in 2009 is as serious and as grave as it has ever been. Yet it is by no means hopeless. If we choose to act wisely and responsibly, we may yet bring the worst excesses of the pandemic under sustained control and management.

But effective global HIV/AIDS containment first requires us to understand how and why we got into this mess.

While the HIV virus is a product of natural viral evolution, the HIV pandemic itself occurred as a consequence of a series of misguided and often malicious political decisions taken by many national governments and international institutions over the past two decades. The rate at which the HIV virus spread had very little to do with its inherent infectiousness, which is low compared to, say, influenza or tuberculosis. Rather, its transmission was greatly accelerated by those governments and societies who misguidedly based their response to the emergence of HIV on faith and fear, rather than science and evidence.

The relentless stigmatization of those initially at greatest risk of HIV infection — gay men, sex workers, itinerant workers and injecting drug users — transformed what was a completely manageable outbreak of a new disease into a global catastrophe. HIV is not a natural disaster, like a tsunami, nor is its spread inevitable or unstoppable. Thanks to a tremendous scientific effort, we now have a range of highly-effective anti-retroviral therapies (ART) with which to treat HIV infection and greatly delay the onset of AIDS.

In Ethiopia, I have seen the astounding difference that ART can make to the health of a mother and child with HIV. In just three months, the mother and child were transformed from virtual sacks of skin and bones on the verge of death to happy, thriving human beings again. With the creation in 2002 of the Global Fund to Fight AIDS, Tuberculosis and Malaria and the US Government's $US50 billion funding of the President's Emergency Program for AIDS Relief (PEPFAR), well over 2 million people have been placed on ART treatments in less than a decade.

We know ART works. But globally, we are still a long way short of universal access to ART. To make sure that everyone who requires ART has access to these life-saving therapies is just a question of money and distribution.

In 2010, the Global Fund will go cap in hand to the international community (including Australia) to seek more funding to continue to distribute ART therapies to the poorest and neediest countries. At the last Global Fund replenishment in 2007, the Global Fund raised $US10 billion for the period 2007-10, of which about half went to HIV-related programs. Next year, the Fund will seek well in excess of that $US10 billion figure to support and expand its highly successful and rigorously-supervised HIV interventions throughout the developing world.

But containing HIV is about far more than just providing treatment for all those with HIV infection. We must avoid falling into what I call the 'treatment trap'. The provision of treatment is costly, hard to sustain and very difficult to provide in countries such as Papua New Guinea, where primary health-care systems are fragile or non-existent.

In the commendable rush to treat, the international community has lost focus on prevention.

There is no prospect of an HIV vaccine being developed in the immediate future, much less being made available at scale throughout the world. We know from bitter experience that if people are provided with honest information about how HIV is transmitted and with the simple and cheap technologies of condoms and clean needles, they will eagerly make the small, sustained changes in sexual and drug-using behaviours that will protect them and their families from HIV infection. We must give them this information and these simple tools.

The toll of death, pain and suffering caused by the HIV pandemic is all the more appalling because it was avoidable and preventable. The politics of fear, victimization, intolerance and prejudice brought about the HIV pandemic. As the bigoted anti-gay legislation presently before the Ugandan parliament demonstrates, religious fundamentalists will not be deterred by evidence as they try to use HIV control as an excuse to indulge their prejudices and hatreds.

A renewed commitment by the governments of the world to HIV policies based on compassion, the respect of human rights and dignity and, above all, the provision of adequate funds for care, treatment, research and prevention offers our best chance of reducing and ultimately removing the scourge of HIV/AIDS from our planet.

The choice is ours.

Photo by Flickr user mvcorks, used under a Creative Commons license.