Since the first identification of AIDS in 1981, and the discovery of its causative agent, HIV, in 1983, HIV/AIDS has become a dominant global public health priority with a wide range of political, humanitarian, and economic implications.
The pandemic has taken a devastating toll in the past few decades. According to USAID, a government agency that provides U.S. economic and humanitarian assistance worldwide, an estimated 60 million people have been infected with HIV and 25 million have died due to AIDS since the 1980s. Though billions of dollars have been invested in HIV/AIDS prevention and treatment, HIV/AIDS still remains a leading cause of mortality and morbidity in developing countries three decades after its recognition, particularly in sub-Saharan Africa.
As HIV/AIDS has been largely controlled in developed countries, and as other domestic issues – such as debt and deficit crises – consume international attention, is combating HIV/AIDS becoming less of a global priority for donor countries and international organizations? After thirty years of awareness campaigns and massive international investments into treatment and control, is the world becoming desensitized to HIV?
First, it is important to acknowledge how far we have come in our fight against HIV/AIDS in the last three decades. The development of antiretroviral drugs (ARVs) – medications for the treatment of infection by retroviruses like HIV – has resulted in greater control of the disease and a prolonged, better quality of life for those infected. Multilateral action on awareness and prevention techniques has resulted in a decrease in the number of newly detected cases each year, as well as a decrease in the number of AIDS-related deaths worldwide.
Efforts in HIV/AIDS education have also helped to reduce the stigma around the virus, which has made dealing with the crisis a lot easier. Today, the life expectancy of someone who is HIV-positive in the developed world is comparable to someone is who HIV-negative. In the developed world, being HIV positive is no longer a death sentence.
While great strides have been made in the fight against HIV/AIDS, many challenges still exist. Though incidences of HIV has declined, prevalence remains high. Millions of individuals, particularly in low and middle-income countries, are still in need of life-saving ARVs. According to the 2010 report by Médecins Sans Frontières, of the 9.5 million people in low and middle-income countries who are in immediate need of life-saving ARVs, only 4 million have access to the medicine, leaving 5.5 million people to cope without. Thus, HIV is still a very serious issue for those infected in the developing world.
An often overlooked challenge in the fight against HIV/AIDS is a trend known as “AIDS fatigue,” or the apathy regarding this issue as the public increasingly feels that the problem doesn’t affect them, or isn’t as urgent anymore. In the past few years, AIDS activists have become concerned with the waning interest in solving the AIDS crisis, as the spotlight on HIV/AIDS has been fading. Many assume that, since HIV/AIDS is treatable and has been controlled in the developed world through near universal access to ARVs and effective prevention strategies, the crisis is over. It is this attitude that influences how we continue to respond to the crisis, and, unfortunately, it seems that we are sending the wrong message.
The most significant consequence of “AIDS fatigue” is its effect on international funding done by organizations and donor countries. As people become less interested in fighting the epidemic, and as many HIV/AIDS targets come into their final years, many governments and organizations are not renewing their efforts to combat the crisis.
Goal Six of the Millennium Development Goals includes the halting and reversal of HIV/AIDS by 2015, but, without proper funding, the only reversal we will see is from the progress we have made in the last 25 years. For example, the Global Fund for AIDS, Tuberculosis and Malaria has played an important role in combating AIDS, providing treatment for millions of people who would otherwise not have access. But, according to the 2010 report by Universities Allied for Essential Medicines, the Global Fund reduced its contributions to 11.8 billion dollars in 2010, which public health experts say is a shortfall of 5 billion dollars and is not even enough to cover its existing projects. Not only will those 5.5 million people not receive treatment, but some of the other 4 million people with access may no longer be able to afford treatment.
The reduction in funding has many other implications. It means prevention initiatives and treatment expansion will now have to fight for funding, exacerbating the argument of whether prevention or access to treatment for HIV/AIDS is more important. Due to interruptions and inadequate treatment, strains of HIV resistant to the original ARVs have surfaced, necessitating the provision of second and third line drugs. Decreases in funding will limit the research for new drugs to keep pace with the proliferation of resistant strains of HIV. Additionally, the high cost of these new, patent-protected drugs will make them increasingly unaffordable for the millions who need them. As the World Health Organization (WHO) and other NGOs typically only provide first line drugs, these new ARVs will likely only be available to those in developing countries who have the means to purchase them out of pocket.
The fight against HIV/AIDS is at a pivotal juncture. The decisions made now by donor countries and international organizations will have tremendous implications for HIV/AIDS treatment and prevention. These effects will be felt by all those who, whether directly or indirectly, are touched by the epidemic. It is imperative to tell the Canadian government that they should increase their financial support to the Global Fund, as well as meet their promise to the Millennium Development Goals to commit 0.7 per cent of Gross National Income (instead of the 0.32 per cent they are giving now) to official development assistance. But just as importantly, we should recognize that HIV/AIDS is still a pressing issue, and, even as we turn to other issues, we need to see that contributing to “AIDS fatigue” would allow millions of people to continue dying unnecessarily.
We have to work to keep AIDS in the spotlight until all those who are infected have access to treatment, and until we see substantial control over the spread of HIV. We must ensure that complacency does not become the dominant policy for dealing with HIV/AIDS.