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The SIPRI Global Health and Security team attended a conference sponsored by Médecins Sans Frontières in October, which discussed progress in addressing HIV/AIDS over the past 30 years. And the progress has been incredible: the Global Fund to Fight AIDS, TB and Malaria provides 70 per cent of funding for HIV medications in low- and middle-income countries (LMICs) and thanks in large part to their efforts, there has been a drop in mortality rates and the rate of new infections is at its lowest in 15 years.
However, these gains are at risk of being reversed, as the Global Fund has not secured donations for its next round of funding. This means it will not be making any new grants until 2014, at the earliest, and even current programmes are jeopardised.
In light of the global financial crisis and its continuing effects, we are seeing a general move towards austerity. But funding HIV treatment is not something to be austere about and is something countries with high burdens can ill afford. Most sub-Saharan countries have rates of anywhere from 10 to 40 per cent. When individuals are on treatment, they can work and contribute to society and the economy which in turn supports their countries’ growth and increasing ability to fund their own healthcare (most health projects are partially funded by recipient governments). Treatment is also prevention, as individuals on anti-retrovirals are significantly less likely to transmit the infection to others because their viral loads are so low. Finally, if treatment is stopped, individuals generally experience a fairly rapid increase in viral load and drop in immune system function; they are also at serious risk of developing resistant strains to medication when (if) they are able to resume.
There has been much discourse recently on the place of middle-income countries in aid as most of them are both donors and recipients. India, as one of the main producers of generic AIDS medication, certainly plays a role. China has been uneasy about entering the ‘Western’ aid infrastructure. As Western countries cut back on their aid commitments, this may be a time for emerging economies to take a larger role. Because someone has to.
A recent edition of Women’s Hour on the UK’s Radio 4 highlighted the over 50s as being the fastest growing group in the UK with HIV, whilst another noted that nearly a quarter of those infected in the UK do not know. And these figures are broadly similar across Europe. Although the burden of this disease is vastly more pronounced in places like sub-Saharan Africa, with about two-thirds of all people living with HIV, it remains a concern in high-income countries as well. All the advances in treatment beg the question who still dies of AIDS? And one of the main groups are people who have never been tested before and are diagnosed late, coming into the health care system with opportunistic infections. These people are twice as likely to die in the first few years after diagnosis as someone who was diagnosed early. Being tested early and getting treatment means you have control over the virus, rather than the virus having control over someone whose infection has progressed to AIDS by the time he or she seeks treatment. So, this AIDS day, we encourage our readers to get tested and know their status for the sake of your ‘personal health security’.
And, of course, another main group of those still dying of the disease are the 50 per cent of people, mainly in low-and middle-income countries who don’t have access to anti-retroviral therapies at all or those who don’t have access to newer medications released after 2005, which remain under patent protection. Writing from Stockholm, it is impossible to imagine not having access to these medications, but for the sake of global health security we ask you to try to imagine yourself in this position and to work with policy-makers to ensure that funding is in place. In these difficult times, AIDS austerity is not something we can afford.