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A World Still Burning Red

It took long enough—two decades or more. But when it finally sunk in that the world burned red from HIV and AIDS, the planet kicked itself into action. Millions were dying each year from the epidemic, all over the globe. A movement was long overdue.

The world recognized the urgency of the AIDS pandemic by forming the Global Fund for AIDS, Tuberculosis (TB) and Malaria in 2002, creating a massive partnership between governments, the private sector and affected communities to funnel billions toward AIDS programs.

In 2003, the U.S. passed a Global AIDS bill authorizing $15 billion to fight the AIDS pandemic over the next five years (2003-2008). The funds would support the new President’s Emergency Plan for AIDS Relief (PEPFAR), created the same year to increase HIV prevention and treatment worldwide. By 2008, U.S. spending on global AIDS had increased so much that Congress authorized $48 billion for the next five years (2008-2013). Now, the Global Fund supports about half of the world’s poor who are getting treatment; PEPFAR pays for the other half.

Many activists and NGOs played a role in stirring up the passion for AIDS over the past decade. Unfortunately, that passion has slowed to a simmer in the past two years. As the next generation of activists, our job is to stir up that energy once again. To do that, though, we need the facts about the current status of global AIDS. We need to know the good, the bad and the ugly.

The Good: Fewer Deaths

In July this year, the International AIDS Conference in Vienna (“AIDS 2010”) drew 19,300 participants from 193 countries. Speakers at the conference revealed multiple positives in the AIDS fight. Most encouraging: The HIV epidemic has stabilized globally, with annual numbers of deaths declining from 2.2 million in 2004 to 2 million in 2008.

While the HIV infection rate remains high, the epidemic is not worsening. Since fewer people are dying from AIDS now than they were 10 years ago, it simply means more people are living with HIV/AIDS.

“Ten or 15 years ago, there was little hope for those in the hardest-hit countries,” says Craig Jaggers, Senior Policy Advisor for World Vision. “When you were found to be HIV positive, it was just assumed that you were going to die, because you couldn’t get access to treatment. Through PEPFAR and through the Global Fund, the number of people who are able to get treatment now has gone up—it’s brought people back to life who were at death’s door. There are now millions on antiretroviral treatment who would not otherwise have been.”

The global scale-up of HIV treatment and increased access to antiretroviral (ARV) medication over the past 10 years played a large role in reducing AIDS deaths. Generic medications have brought prices down. In the past five years, coverage of HIV treatment in low- and middle-income countries increased tenfold to now reach 5 million people. All this progress over the past decade proves that universal access to HIV/AIDS treatment is achievable.

The Bad: AIDS Fatigue

We’ve made some crucial steps forward, but the AIDS fight is not over. Around 2.7 million new HIV infections occur each year. Despite the scale-up of treatment, there are still five new HIV infections for every two who gain access to treatment.

“The challenge in that is that we’re seeing fatigue on the issue of AIDS,” Jaggers says. “It was a rallying cry to get the Global AIDS bill passed, and it got a lot of high-level attention from Christian leaders, but that has seemed to dissipate. People grow tired of working on this. But it’s not something that’s going to be solved in a short period of time.”

Ten years is a long time for intense global focus on one issue, but that’s the kind of commitment the AIDS pandemic needs. According to the UNAIDS Annual Report 2009, 33.4 million people are still living with HIV—and two-thirds of them live in Sub-Saharan Africa. The U.S. steadily increased spending on AIDS over the past decade, and that’s good—but since 2008, spending has leveled off again. If we want to end the pandemic, we have to keep scaling up.

The New York Times reported on Oct. 5 that “the global battle against AIDS is falling apart for lack of money.” Despite the Global Fund’s stated need of $13-20 billion for the next three years, pledges from 40 countries so far have amounted only to $11.7 billion.

“AIDS became a hot topic, but after several years, people started to think, ‘OK, check, we’ve done AIDS,’” says Bob Zachritz, World Vision’s Director of Advocacy and Government Relations. “But we need an increase in funding. We have to keep it big.”

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The Ugly: Controversy

As always, differences threaten the unity of the global AIDS response. Some argue that failure to recognize human rights violations leads to oversimplified prevention programs. Many activists at AIDS 2010 pushed for a shift away from the current “War on Drugs” approach toward a new evidence-based approach. Many want policy change that recognizes the human rights and medical needs of especially high-risk groups, such as drug users and sex workers.

But not all agree. Some feel that a whole-scale shift to a human rights approach would focus too much on specific populations and ignore the fact that HIV/AIDS remains a generalized epidemic. Some claim the new approach rings slightly vague: cheering for human rights sounds good—but how do you define “human rights”? Would reducing laws that marginalize or criminalize drug users, who are highly at risk for HIV, mean fewer obstacles for drug traffickers? Would it create other social problems?

There’s also the new strategy of “treatment as prevention,” based on the notion that treatment decreases the viral load, which lowers the risk of HIV transmission. But others fear that adopting this strategy could siphon money from effective prevention programs, such as ones dealing with mother-to-child transmission.

However, World Vision International News Manager Geraldine Ryerson-Cruz, who attended AIDS 2010 in Vienna, says those fears spring from misinterpretation. “’Treatment as prevention’ could be easily misunderstood as trying to promote treatment rather than other forms of prevention,” she says, “but the real takeaway should be that earlier and more comprehensive treatment will help prevention be more effective.”

Of course, earlier treatment means more people on treatment, and with global AIDS funding flatlining or decreasing, that can’t happen. “This underscores how vital it is to find those resources somehow and scale it up,” Ryerson-Cruz says. “We can’t just kick back and rest.”

Lauren Seibart is an ACT:S Advocacy and Campaigns Fellow. To learn more about what World Vision ACT:S is doing to help combat HIV/AIDS and how you can help, visit WorldVisionACTS.org.

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