Belfast Telegraph

We're winning battles but Aids war is far from over

By Jim Clarken

Delegates arriving at the 18th International Aids Conference in Vienna this week could be forgiven for not knowing whether to pat themselves on the back or beat themselves around the head.

Those inclined towards self-satisfaction can point to significant victories in the fight against HIV and Aids: the number of people becoming infected with HIV each year has fallen by 17% since 2001, the number of infected people receiving treatment has increased tenfold in five years, and the number of deaths has fallen by 10%.

But the head-beaters also have a strong story to tell. In spite of the improvements, more than half of people with HIV and Aids do not receive the treatment they need to stay alive.

The situation remains particularly bleak in much of sub-Saharan Africa, which accounts for 60% of those living with HIV, two-thirds of new infections and almost three-quarters of all Aids-related deaths. In 2008, two million people died of Aids and nearly three million were infected with HIV.

This relative lack of progress is disappointing when you realise that 2010 is the year by which world leaders promised those at risk from HIV and Aids universal access to prevention, treatment and care. So why has the world failed to live up to the intentions of its leaders in 2001? Inevitably, a large part of the answer is cash.

The fact is that donors have not been willing to find the funds necessary to halt the spread of HIV and treat those already infected.

Worryingly, there are signs that rather than stepping up their efforts, donors are seeing the limited successes so far as a reason for complacency.

The Global Fund to Fight Aids, Tuberculosis and Malaria - responsible for saving almost five million lives - is running short of money.

If universal access is to be achieved anytime soon, then donors must find a minimum of $20bn to replenish the Global Fund for the next three years.

But it would be wrong to pretend that HIV is a problem that can be solved only by governments of rich countries or by a reorganisation of the way aid is delivered. African governments have a critical role to play. They committed to allocating 15% of their national budgets to health and HIV, but only a handful of countries, including Malawi and Botswana, meet this target. Some 11 African countries currently spend just $5 per person annually on health.

And now, under pressure from the economic crisis, too many are backtracking on that target. In March, South Africa, Rwanda and Egypt successfully fought for the pledge to be quietly dropped by African Union finance ministers.

This is deeply alarming. Unless governments of both north and south commit additional funds, then universal access to HIV prevention, treatment and care will remain an unattainable goal.

Tackling HIV and Aids will need additional resources, but the battle will be lost if discrimination and prejudice are not dealt with head on.

Some governments are jeopardising the fight against HIV by enforcing punitive laws and practices. In Sierra Leone, for example, an offence was introduced into the law in 2007, criminalising people with HIV who put others at risk of infection - even pregnant women who pass the virus to their unborn babies.

And this is not just an African problem. In 2008, an HIV positive homeless man in the US state of Texas was sentenced to 35 years in jail for "harassing a public servant with a deadly weapon". His crime? Spitting at a policeman while drunk.

These laws are an attempt at a shortcut to bring HIV under control. But - as with legislation targeting homosexuals, sex-workers, drug-users and illegal immigrants - they make it more difficult for people at risk of HIV to take steps to prevent infection.

These laws also discourage those who fear they might be HIV-positive from being tested and receiving treatment.

The sad reality is that almost a decade after the world's leaders promised to halt the Aids epidemic, progress is under threat from actions in both rich and poor countries.

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