In Poor Nations, a New Will to Fight AIDS
By PETER PIOT
On the eve of next week's International AIDS Conference in Barcelona, a new report from the United Nations AIDS program states that at current infection rates, AIDS, the deadliest epidemic in human history, will kill 68 million people in the 45 most affected countries over the next 20 years. More than five times the number claimed by AIDS in those nations in the past 20 years. In some of these nations, AIDS could kill half of today's new mothers.
This need not happen. H.I.V. prevention campaigns work, and there is overwhelming evidence that the AIDS epidemic can be controlled but only when governments make fighting AIDS a priority.
A handful of developing countries are proving this. Uganda, devastated by years of dictatorship and war, has also been ravaged by one of the highest H.I.V. prevalence rates in Africa. But after infection rates in the capital city of Kampala reached more than 30 percent in 1990, leaders in Parliament, urban neighborhoods and villages began to talk frankly and publicly about H.I.V. and AIDS. Community groups started education and prevention programs. Today Kampala's H.I.V. prevalence rate is 11 percent and falling.
Zambia may become the second African nation to reverse its epidemic with education and prevention campaigns mounted by government and local communities. The prevalence of H.I.V. has fallen among young women in both urban and rural areas to 24 percent in 1999 from 28 percent in 1996 in cities and to 12 percent from 16 percent in the countryside.
In Cambodia, a society that is still emerging from genocide and conflict, large-scale education and prevention programs (including steps to counter the stigma of H.I.V. and AIDS) have led to a decline in adult H.I.V. infection rates ? to 2.7 percent at the end of 2001 from 4 percent in 1997. And in Brazil, where access to H.I.V./AIDS treatment is constitutionally guaranteed, the number of AIDS deaths is plummeting and prevention programs are succeeding in some of the groups that are at highest risk for infection.
There are other hopeful signs. Almost 100 countries now have national AIDS strategies. Governments have signed a United Nations declaration pledging to achieve specific global targets in fighting AIDS and creating an international framework for accountability. These efforts are to be applauded, but they are not enough.
What's missing? Money, for one thing. By 2005, $10 billion will be needed annually to finance a basic response to H.I.V. and AIDS in developing countries alone. This year about $3 billion will be available from national government programs, international aid and private donors. That is nearly twice what was spent on AIDS in developing countries in 2000 but still far f rom sufficient. What's needed to get to $10 billion is an increase of 50 percent a year in funds directed at fighting AIDS ? in each of the next three years.
The price of lifesaving H.I.V. drugs has been reduced dramatically for some developin g countries. But even at the lowest reduced price $350 a person annually ? the drugs are unaffordable in nations most in need. Last year, 30,000 people in sub-Saharan Africa received antiretroviral drugs; in the same period, 2.2 million people died of A IDS.
The new, independent Global Fund to Fight AIDS, Tuberculosis and Malaria is an important source of funds for development countries, providing roughly $350 million in new money in its first round of grants this year. (In April, fund offic ials announced they had received pledges totaling $2 billion from governments, foundations and individuals.) But the fund alone cannot bridge the resources gap. That will require a collective effort: country-to-country assistance programs, participation b y foundations and business, increased government spending in developing countries and international debt relief programs to allow increased spending.
Failing to invest in an effective AIDS response undermines every other development goal. At last year's United Nations special session on H.I.V. and AIDS, delegates made it clear that the broader development goals agreed on at the Millennium Summit in 2000 on education, literacy, infant mortality and agricultural and economic progress cannot be met if we do not tackle this disease.
Uganda, Zambia, Cambodia, Brazil and other developing nations have demonstrated that AIDS is a problem with a solution. Now the world must match this leadership and commitment with the resources needed to get on with the job. Otherwise, the new spirit of hope and vigor in the AIDS fight will be dashed. The costs of that are too devastating to contemplate.
Peter Piot is executive director of Unaids, the Joint United Nations Program on H.I.V./AIDS?