Reflections on World AIDS Day

Another World AIDS day has come and gone. Global interest and expenditures on HIV/AIDS are at record levels. While interest and expenditures are prerequisites to winning this war, they are not sufficient. It’s time to assess where we are in the struggle against HIV/AIDS.

Some countries have made progress. Kenya and Zimbabwe in particular have made inroads against HIV/AIDS. Data suggests that the prevalence of HIV/AIDS in Haiti and other parts of the Caribbean are slowly being reduced. Congratulations to Partners in Health, GHESKIO, Project Medishare, and other NGOS actively engaged in HIV/AIDS prevention, care, and treatment in Haiti. Considering the lack of government capacity, the NGOs have taken on a true leadership role that has been a model for many other countries.

But this is the good news. Despite out efforts, there has been a global increase from 37.5 million people with HIV/AIDS in 2003, to 40.3 in 2005. Richard Holbrooke notes that we are still losing this war, but we are losing it more slowly. We cannot be complacent.

We’ve learned a lot over the years. We’ve learned that political will is a critical element of effective programming but it is not enough. The private sector, the faith based community, all government agencies, and grassroots organizations must work together for sustainable change.

We’ve made advances in treatment. Each year, the cost of generic medications is reduced. The United States Government has approved several different generic medications to treat people living with HIV/AIDS through the President’s Emergency Plan to Fight AIDS Relief (PEPFAR). Over one million people in low to middle income countries are being treated with Anti Retroviral Therapy (ART). This is more than ever before, but not nearly enough.

Successes in treatment are exciting indeed. Yet, treatment is for life and we are not able to provide ART to everyone with HIV/AIDS who needs it. Prevention is the key…yet we are not good at it. In fact, we have done a miserable job. We’ve learned that fear based appeals are ineffective and often stigmatize the vulnerable populations we serve. We know prevention does not work with people who cannot protect themselves. We’ve learned to design, implement, and monitor/evaluate programs with populations served….but not on a grand scale. All institutions of society from church to voodoo temple, from school to clubs have a role to play in prevention. Some mass media campaigns have been effective, some have not. Those that stand out were designed by community members themselves. Activities that entertain and educate (edutainment) show promise, and should be encouraged.

Voluntary Counseling and Testing (VCT) ties together treatment and prevention. Most people, here in Washington DC the same as in many parts of the developing world, do not realize they are HIV positive. VCT, when done in a culturally appropriate and non stigmatizing manner is critical as it informs people of their status. An important ethical question is whether it is acceptable to treat people without treatment being available. Although people will certainly search out VCT more aggressively when it is a prerequisite to treatment, it allows people to know their status, their options, and how to protect their partners. It will also allow providers to give them better care and identify social support mechanisms for them when they exist.

There are other problems though. Africa and many other parts of the world, including Haiti, are absolutely hemorrhaging health care providers who leave to take jobs in the developed world. HIV/AIDS programs need doctors, but they often find themselves over-extended. To expand, programs need nurses and counselors who are committed to both cause and community. In fact, some of the best counselors are people living with HIV/AIDS themselves.
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We find ourselves treading water until we have a vaccine that will be effective in inoculating people against all subtypes of HIV. Until then, we must redouble our efforts every year until we begin to win this war. So what can we, as concerned citizens, do to make sure that we will eventually win this war?

Keep pressure on our politicians. Encourage them to support the Global Fund, PEPFAR, and HIV/AIDS research programs. Criticize when they do not take action, but just as important, praise them when they do. Recognize that even politicians with different worldviews must be engaged. Bono has done an excellent job of handing off ideas to both conservative and liberal politicians and then letting them take credit. Effective advocacy involves working with private and public leaders across the spectrum.

Support non-governmental organizations like Project Medishare and Partners in Health that are making a real difference in places like Haiti. Spread the word about what they are doing and why HIV/AIDS is a moral, economic, and development emergency.

Stay informed, and keep others informed. Next year, it is my hope that we will not have to say that we are losing more slowly, but that we are winning more rapidly. It’s up to every one of us and our ability to engage ourselves, our governments, and our institutions. Next year can be different. Let’s work together to see that it is.
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Bryan Schaaf

Haiti Innovation