To Be Equal:
The global AIDS fight

Marc H. Morial

Currently, the world’s nations contribute more than $5 billion a year to the global effort to fight the spread of HIV, the virus which causes AIDS.

So, at first glance, one might be inclined to dismiss the recent charge made by one AIDS expert that “the world is seriously under-investing” in preventing the spread of the scourge.

But if we widen our glance to consider some of the numbers contained in the just-released annual United Nations report on AIDS, we’ll gain a sobering perspective on the funding fighting AIDS deserves.

We’ll see that just because the official World AIDS Day, Dec. 1, has come and gone, doesn’t mean we shouldn’t consider every day World AIDS Day.

For example, the number of people infected with HIV has doubled in the past decade to 40 million worldwide—nearly half of whom are women, and 2 million of whom are children. More than 3 million people around the globe have died this year of AIDS-related illnesses; that’s a rate of 60,000 per week. More than 500,000 of them were children.

The massive global effort that $5 billion supports—involving research into vaccines, public education campaigns and large-scale distribution of the antiretroviral drugs which retard the disease’s ravages—has produced some notable successes.

But in nearly every country where HIV/AIDS has a significant footprint, the pandemic is spreading faster than efforts to prevent new infections and treat those already sick

In other words, the scourge shows little sign of being brought under control.

“It is increasing everywhere,” said Jim Yong Kim, director of HIV-AIDS for the World Health Organization, in November upon the UN report’s release, “We really are failing in attempting to prevent the epidemic in most of the world.”

As has been evident for years, the situation is grimmest in sub-Saharan Africa. More than half of those with HIV in the world live there; 75 percent of the world’s AIDS-related deaths this year have occurred there, as have nearly two-thirds of this year’s 5 million cases of new infections.

In this welter of grim statistics, the most alarming of all may be that in this region, where medical systems are weak and frequently overwhelmed by high caseloads of AIDS, only one in 10 of those infected with HIV is getting antiretroviral medicine.

In other words, the dynamic of a hollowing-out of the humanity of much of Black Africa continues.

But there is plenty of cause for concern in other regions of the world as well: a record number of new infections in Latin America; a spike in infection rates in Indonesia and Pakistan, and, though the absolute numbers are small compared with Black Africa, “growing epidemics,” according to the U.N. report, in Eastern Europe, India, China and East Asia.

The full effect of HIV/AIDS has been sharply blunted in the developed nations of Europe, Canada and the United States by the widespread availability of antiretroviral drugs. But, even in the West, the persistence and danger of the scourge is underscored by the fact that, with many perhaps seduced by the relative disconnect between AIDS and death, the number of overall infections has risen.

Amid these multiple causes for dismay, however, are signs of hope of what can occur when concentrated efforts are made to beat back the disease: the stabilization or reduction of rates of HIV infection in such varied countries as Zimbabwe, Kenya, Burkina Faso, Argentina, Lesotho, Swaziland, Cuba, and Chile. The most dramatic instance is Brazil, where the Brazilian legislature’s mandating free antiretroviral treatment for all HIV-positive citizens eligible for national insurance a decade ago has produced sharp declines in the country’s AIDS-related death rates.

And in the United States, where African Americans are far more likely to contract HIV/AIDS than other groups, their rate of newly-reported infections has been dropping by about five percent a year, according to the federal Centers for Disease Control and Prevention.

While the situation of African Americans vis-à-vis HIV/AIDS remains dire, there’s no question that the decline reflects the concentrated efforts of black community leaders, the Congressional Black Caucus and the CDC to fund national as well as local community AIDS prevention and education efforts.

Thus, the proof exists both within and outside our borders of the critical role, in the words of Dr. Peter Lamptey, the top AIDS official of the nongovernmental organization, Family Health International, “political will and astute leadership [can] play … in the global fight against the AIDS epidemic.”

The missing piece thus far is more money, according to Richard Feachem, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria. He asserts that the current $5 billion annually needs to be quadrupled to $20 billion in order to produce dramatic, large-scale declines in new infections and deaths. “Investment in AIDS works,” he says.

Surveying the wrenching trail of misery and death the AIDS pandemic has already forged, one could add: think of the alternative.

Marc H. Morial is president and chief executive of the National Urban League.