Promising news on curb of epidemic overshadowed by donor-fatigue
WORLD AIDS DAY, celebrated today the world over, has brought with it both good and bad news, the former being that for the first time since the epidemic was identified thirty years ago, there is a sense that the end is in sight. According to local advocates, the National AIDS Committee (NAC), the perceived optimism has to do with the sharp decline in the number of new infections over the past five years, thanks to “a combination of better protected sexual activity and better access to anti-retroviral drugs.
The bad news, however, is that “for the first time since the epidemic was identified, global resources committed to the epidemic have been reduced in what is seen as a long-term shift by major donor governments to other priorities.”
Still on the bright side, NAC says in a release that a recent study done by UNAIDS (the Joint United Nations Programme on HIV and AIDS) has found that due to “a dramatic increase” (by some 20%) in the availability of ARVs over the last two years, there has been a significant decrease (down from 2.2 to 1.8 million since 2005) in the number of AIDS-related deaths.
It also cites better access to ARV as being responsible for the significant drop in infection rates in poor countries the world over, including the Caribbean, which in turn has averted a further 2.5 million deaths.
According to NAC, the UNAIDS study has found that since 2001, there has been an estimated 25% reduction in new infections in both Jamaica and The Dominican Republic, and a steep decline as well in the number of children newly infected with HIV, and in AIDS-related deaths among children.
As to assessing whether ‘Getting to Zero’ (a shortened version of this year’s theme for World AIDS Day) is realistically possible in the Caribbean, NAC says such an activity will entail taking into account a number of counter-measures, such as behaviour change, scientific progress and legal changes, largely in the areas of hetero-sexual activity, which remains the main means of transmission of the virus.
For transmission rates to fall effectively, in the context of hetero-sexual activity, NAC says, persons will have to commit to having fewer sexual partners and more protected sex.
On the scientific side, such behaviours have been complemented by a sharp decline in mother-to-child transmission (MTCT), universal or high levels of access to drugs in Caribbean territories, and male circumcision.
In the area of legal and policy change, NAC says, violence against women and girls, and the lack of control among females over their sexual urges and activities have tended to contribute significantly to hetero-sexual transmission, while whatever gains have been made in areas of stigma and discrimination remain fragile and vulnerable to being wiped out by bouts of homophobia and the effects of economic austerity.
The organization says that while the foregoing information is intended to prove that the fight against HIV appears winnable, that reality is on the horizon, and not around the corner.
“Whether ‘Getting to Zero’ will be achieved depends crucially on sustained application of substantial funding. At the present time, such funding is in serious jeopardy,” NAC says.
Besides the Global Fund for AIDS, TB and Malaria (GFTAM) being reportedly under-funded to the tune of US$8.3 billion, the agency says, despite commitments made at the HIV High-Level Meeting (HIV-HLM) of Heads of Governments in June this year, following unprecedented pressure from activists around the globe on securing universal access to drugs, major donor countries, faced themselves with international financial turmoil, are losing sight of HIV priorities.
Even without the more recent financial upheavals, it says, signs of donor fatigue have been evident for some time now, the latest being the recent HIV-HLM meet where it was made clear that “…sustained universal success in the fight against HIV will depend on national governments assuming greater responsibility for funding access to drugs.”
Noting that universal access to anti-retroviral drugs is key not only to reducing AIDS-related deaths but to making people less infectious, NAC says that for countries like Guyana, which reportedly enjoys an 80% access to ARVs, assuming greater responsibility for funding access to drugs will pose an alarming challenge.
“Assuming the full financial burden of providing ARV is an unrealistic proposition in such circumstances,” NAC says, adding: “What is within reach of countries in a similar position to Guyana is that they redouble their efforts to support initiatives at the local and international level, which could offset the apparently inevitable financial short-falls.”
Noting that a major area of attention in this regard is the production of generic drugs, NAC says:
“An agenda of activities within the grasp of such countries include challenging the regulation of international commerce, known as TRIPS, with respect to production of generic drugs. Crafting artificially-inflated prices of anti-retroviral drugs and sustaining patents long after they have originally expired are techniques regularly employed by pharmaceutical companies. These techniques need to be challenged in order to allow generic drugs to be more widely and readily available.
It gives as a typical example of the actions which affect countries like ours a case being played out in the Indian High Courts at this very moment.
“The Swiss pharmaceutical company, MNC Novartis,” NAC says, “is challenging the constitutionality of a clause introduced into the relevant legislation by the Indian government in order to stop the practice of ‘ever-greening’, whereby companies such as Novartis extend expired patents by introducing minor modifications to the drugs in question.”
Contending that broad coalitions of affected countries are needed to challenge the global character of pharmaceutical companies, NAC says:
“It is neither morally acceptable, nor politically astute for dependent countries simply to treat such matters as a national concern of producers of generic drugs. Some measure of informed solidarity, rather than simply begging, would increase the validity of claims made for assistance on the international community.
“Within the area of activities identified earlier as contributing to ‘Getting to Zero’, renewed efforts are required to reduce the incidence of violence against women, exploitation of female poverty and to remove discriminatory practices based on homophobia.
“While access to ARV drugs has made a significant – although unexpected – contribution to reducing infection, maintaining low rates of infection is within the grasp of societies which adhere faithfully to protective measures and inculcating habits of respecting and protecting the rights and dignity of all of its population.
“Getting to Zero, in other words, is not solely dependent on the goodwill of other nations:  A combination of the right values, the right behaviour and political will can make a big difference.”
‘Zero New HIV Infections, Zero Discrimination and Zero AIDS-Related Deaths by 2015’ is the full text of the theme this year for World AIDS Day.
The National AIDS Committee, headed by Ms Hyacinth Sandiford, is a voluntary body which promotes HIV/AIDS policy and advocacy issues; advises the Minister of Health; and assesses the work of the National AIDS Programme Secretariat (NAPS) in relation to the National AIDS Programme.
NAC also encourages the formation of Regional AIDS Committees (RACs) and networking amongst NGOs involved in the fight against the HIV/AIDS pandemic.