Inequalities will Continue to Drive New HIV Infections
July 26, 2012
Senior Fellow, Global Health Policy Center
The many aspirational high-notes hit by speakers throughout AIDS 2012 are nonetheless tempered by some underlying realities. Funding for HIV activities has flat-lined and the health of key funding institutions, especially the Global Fund, is arguably fragile. Additionally, economic growth in Africa may be accompanied by increasing disparities between rich and poor, creating the types of vulnerabilities that drive HIV/AIDS epidemics.
In a Plenary Session on July 24, UNAIDS’s Bernhard Schwartländer built a basis for optimism, with some qualifications.
On the upside, the world around us is changing with some helpful ramifications. According to Schwartländer, achieving an AIDS-Free Generation will be possible as all countries, independent of their resources, shoulder the shared responsibility of a comprehensive AIDS response. In the near future, several countries with the highest rates of new infections will also transition from low to middle income status. As a result, the largest share of new HIV infections will emerge from countries with more wealth to invest in health. Already, countries across the globe have increased their spending in support of HIV activities, and they are working to target increasingly effective health interventions, find efficiencies, and do more with less.
On the down side, projections also shared by Schwartländer suggest that the costs of implementing highly effective combination prevention portfolio will rise through 2015. Additionally, treatment costs will continue to increase for some time as more people live longer with HIV. To sustain effective HIV responses, we will undoubtedly need to find new resources. Finally, Schwartländer argued that even as an increasing number of countries achieve middle income status, poverty will remain a problem. Herein lies the paradox of economic growth. If the benefits of economic growth accrue only to the wealthy few, a growing divide between rich and poor within countries predicts that HIV will rise among their poor and vulnerable populations, notably MSM, commercial sex workers, and injecting drug users.
Listening to Schwartländer's talk, I was reminded that, as we look for ways to rein in costs, there may be a tendency to defund ‘unpopular’ but essential activities, especially HIV/AIDS services for the most vulnerable groups. In many countries throughout the world and perhaps especially in sub-Saharan Africa, concerted program activities for these key populations are only now being ramped-up: I fear we may lose hard-won momentum. It will be a test of global compassion to ensure that countries’ poor and vulnerable people are not left behind. At the same time, it will be up to countries to prioritize the needs of their most disadvantaged citizens, district by district, ward by ward, and village by village.