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Kolleen Bouchane

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We Can End AIDS Redux

Posted: 07/24/2012 2:44 pm

I don't function well in crowds. I get anxious and nauseated. So on Sunday night last, as I funneled my body through the corridor of the Washington, D.C., Convention Center, shuffling shoulder-to-shoulder with 10,000 other humans while the sun beat down through the massive windows on our tense and sweaty faces, I thought: "This better be worth it. Also, don't vomit."

But I continued to press into the opening session of the 19th International AIDS Conference.

And it was worth it. For two reasons (not including Sharon Stone). First, I got to hear what was said, and then more importantly, I got to hear what wasn't.

First, what was said.

The highlight of the night was Dr. Jim Kim, the newly minted president of the World Bank. Dr. Kim is a bit of a superstar in the global health arena -- respected for his thoughtfulness and ambition and held in high esteem by people like me, who hear his outrage on poverty and recognize it as the real deal. Despite the fact that HIV/AIDS is one of the foremost development challenges of our time, no World Bank president had ever addressed the International AIDS Conference before. Dr. Kim's presence alone suggests that AIDS may now be the priority it could and should have been in the past at the Bank.

But Dr. Kim didn't rest on his credentials, he came right out with it: "I will make ending AIDS a signature part of my tenure" as World Bank president.

Dr. Kim's pledge suggests he will begin to rely on the Bank's considerable brain trust to find a way to invest more strategically and demonstrate a more focused, results-oriented approach to support expansion of access to quality HIV treatment and prevention.

Kim and every other speaker well into the night all had the same refrain: "We Can End AIDS." Indeed that's been the mantra of the conference, the hashtag of the twittersphere and the most emblematic statement of the moment of hope and opportunity that many people feel we are in. A rallying cry in the past, these words -- We Can End AIDS -- are now fact.

Since the conference last met in 2010, science has shown that treating HIV through antiretroviral therapy reduces transmission of the virus by 96 percent. Treatment is prevention. Along with voluntary male circumcision, also shown to protect men from becoming infected, and the elimination of transmission of the virus from mothers to their infants, we can actually see the rise of an AIDS-free generation.

But it's not all hearts, stars and rainbows. Plenty about how we are actually going to make this all happen was not said.

First, there was barely any mention of tuberculosis despite the fact that TB is the leading cause of death among people living with HIV. It makes no sense to provide access to antiretroviral therapy to someone, only to allow him or her to die from TB. In several countries in sub-Saharan Africa, upwards of 4 in 5 people with TB are living with HIV. This is not a secret that should be kept from high-level speechwriters any longer! We've known we need to fight TB aggressively if we are serious about AIDS.

Second, few speakers made impassioned calls for new funding for HIV. As world renowned economist Jeff Sachs noted in his address to the RESULTS International Conference the following morning, 'They want us to do more with less. It's a scam! We need to do more with more!" Heaps of praise for Michel Sidibe, the executive director of UNAIDS, who stood out from the crowd with a rousing appeal for $9 billion in new funding for HIV/AIDS each year -- the gap between available funding and funding needed to provide universal access to services and to stop the spread of the virus.

Without resources, the end of AIDS will remain a lofty fiction. The Global Fund to Fight AIDS, TB and Malaria -- the second-largest international funder for AIDS and the largest for TB -- is in a severely fragile funding situation after the cancellation of its 11th round of funding last year. Beyond funding, there are serious threats of a new model for disbursing funding, based not on the proven strengths of the Global Fund but on arbitrary "caps" or country "envelopes." Such a model could undo the most important aspects of country-driven Global Fund supported work, distorting investments and leading countries to limit their own demand. Undermining the Global Fund's core principles will devastate the Fund and the larger fight.

ACTION's new brief, The Global Fund: Progress At Risk, provides specific examples of where the fight against TB will stall unless donors contribute needed resources. "Progress at Risk" also suggests recommendations for actions that will enable the Global Fund to continue to create a strong new funding model and make progress in the fight against TB and TB-HIV.

Monday the Global Fund released new figures that show its impact. They show that 3.6 million people are now receiving antiretroviral HIV therapy, 9.3 million people have been treated for TB, and 115 million insecticide treated bednets to prevent malaria have been delivered through Global Fund-supported programs. Go back and read that again.

This is unprecedented progress, achieved over a mere 10 years. I press anyone to explain to me how we will end AIDS without protecting how the Global Fund works and keeping the Fund on its current trajectory.

Unless leadership at the highest levels is brought to bear on what was not said enough at the opening plenary, ambitious progress against the diseases will stall at the very moment when we are gaining ground. A moral failure of this magnitude is not acceptable.

Kolleen Bouchane is the Director of ACTION, a global partnership of advocacy organizations working to influence policy and mobilize resources to fight diseases of poverty and improve equitable access to health services. ACTION's current focus issues are tuberculosis (TB) -- the leading killer of people with HIV/AIDS -- and increasing equitable access to childhood vaccines.

 

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