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Call goes out to Australia and China to help fund faltering AIDS battle


Peter Hartcher

The biggest global epidemic in recent years? It would have to be swine flu, or H1N1, which has killed 18,239 people already, right? Wrong. That is just the one you have heard most about in recent years because it's new, and that makes it newsworthy.

The world's biggest infectious killer is HIV-AIDS, says the World Health Organisation. It's killed 27 million people so far. But isn't it history? Isn't AIDS a 1980s-'90s thing? The disease was first diagnosed in 1982 and a breakthrough in anti-retroviral drug treatment came in 1996. Hasn't that crisis passed?

It's true that the official rate of new infections worldwide is falling. It peaked with 3.5 million new cases a year in 1996. It then trended down gradually to 2.7 million in 2008. And we know that the spread of the disease is entirely manageable. Australia is a good example. With the right public information, the right strategy and enough funding, Australia has controlled its spread. Only 0.1 per cent of Australians carry the virus. It's the same story with all the world's rich countries, with the notable exception of the US. With six times Australia's rate, it has the same prevalence of HIV-AIDS as Somalia and Costa Rica.

But the real HIV-AIDS crisis may still be ahead of us. And one of the biggest reasons is the complacency that has settled on world public opinion, the idea that it's all under control. There are five chief reasons that the threat is looming as large as ever.

While the downward trend in global averages for new infections is apparently reassuring, that average conceals the fact the epidemic is growing explosively in some countries.

While it's raging in sub-Saharan Africa and eastern Europe, the number of new infections is also increasing in places closer to home. It's rising in large swaths of Asia: in parts of China, in Vietnam, Cambodia and Thailand, and also in the South Pacific, notably in Papua New Guinea.

The epidemic is evolving, too. In China, for example, it was primarily a phenomenon among people injecting drugs, spread by dirty needles. Now, it's increasingly spread by heterosexual couples having sex, as the United Nations' dedicated body, UNAIDS, has reported.

In some countries, there is a total lack of even the most basic understanding. Consider the amazing findings of a serious academic study in Pakistan in 2007, for instance.

Incredibly, 28 per cent of prostitutes had never heard of HIV or AIDS. And 60 per cent didn't know that a simple condom could stop the spread of the disease. This state of affairs in many countries practically guarantees that there will be flaring epidemics in the years to come.

The second reason is that when HIV-AIDS spreads, it spreads more than HIV-AIDS. Much as the initial damage from a nuclear blast is soon followed by a shower of radioactive fallout, HIV-AIDS trails behind it another wave of death and suffering in the form of tuberculosis.

Once AIDS sufferers' immune systems are broken, TB is the disease most likely to follow. And this creates an ever-expanding pool of TB sufferers. Remember that TB is far more infectious than HIV-AIDS and can be transmitted with a simple cough. It's also developing into drug-resistant strains for which there is no known cure. To manage the spread of TB, the world needs to control HIV-AIDS.

Third is the fact that, thanks to the anti-retroviral drugs that keep the infected alive, there is an ever-expanding population of people living with HIV-AIDS. Some 33.4 million people now live with the virus. As this population continues to swell, the cost of supplying anti-retroviral treatment will mount year by year, putting an increasing demand on government and NGO budgets alike.

Fourth is the crisis in funding for HIV-AIDS. There are two big sources of money to fight the disease. One is the Global Fund, financed by the world's rich countries and some big private philanthropists, notably the Bill & Melinda Gates Foundation.

This fund has had a cumulative total of $US19 billion poured into it since it was founded in 2002. It estimates that it needs a minimum of $US13 billion more to continue its work over the next three years. A big donor conference is due in October, and the outlook isn't good.

"The global financial crisis rocked all the donor countries, but what's really rocked them is the second wave that's now going through Europe," where governments find themselves in fiscal crises, says the executive director of the Pacific Friends of the Global Fund, Bill Bowtell.

"The European governments have been fantastic donors in the past, but it seems very unlikely that they can repeat the performance this year, so the outlook is not good," says Bowtell, who was the policy adviser who developed Australia's successful HIV-AIDS policy for the Hawke government.

The other big source of funds is from the US government, the President's Emergency Program for AIDS Relief, which George W. Bush founded with an initial allocation of $US50 billion. It faces a similar problem. "That fund will need a new allocation in the next four or five years," says Bowtell, but with the budget crisis now gripping the US "it's hard to see the US Congress will authorise the money".

Bowtell wants Australia to help fill the global funding gap, and he hopes China will, too. "Until just a few years ago China was a recipient of international money for HIV-AIDS programs - today it could easily make up the shortfall from Europe at the blink of an eye."

The final source of a re-energised HIV-AIDS pandemic is government wrong-headedness. "Wherever sex or injecting drug-users are criminalised or stigmatised, the AIDS epidemic is fuelled," says Bowtell. Because the people who most need screening and treatment will be reluctant to step forward if they risk arrest or social stigma. So the disease spreads. In China, for instance, where drug-users are punished severely, it's estimated that only one-third of carriers have been identified. And 85 countries still have laws against homosexuality, seven of them with the death penalty.

That is why a big HIV-AIDS conference in Austria later this month will issue the Vienna Declaration: "The criminalisation of illicit-drug-users is fuelling the HIV epidemic and has resulted in overwhelmingly negative health and social consequences. A full policy reorientation is needed." That is why, far from being a relic, HIV-AIDS could yet be a 2010-'20s thing, and beyond. In the meantime, it's killing another 2 million people every year.

Peter Hartcher is the Herald's international editor.



  • HIV-AIDS is just one of many problems made worse by current legislation inacted in an effort to stem the flow of illicit drugs.
    Unfortunately there is little chance of any change as long as the US has any say in the matter. The US has their pants nailed to the mast of no change in legislation. Any attempt to change will be viewed by the US as an unfriendly act leading to retributions.

    Date and time
    July 06, 2010, 7:29AM
    • Heady stuff. We all agree HIV-AIDS is an ongoing threat.

      When will the governments of Africa and similar locations be held responsible to deal with this problem? Looking through the article it sounds like the responsibility for AIDS is the responsibility of the West only. An unbelieveable amount has been spent globally to reduce the risk of AIDS, but when you compare the treatment of the Aus government & African leaders you can see money will not solve this problem.

      After the moronic approach of Thabo Mbeki & Jacob Zuma surveys of young people in South Africa reveal do not believe that need to use condoms. Rather they believe that having a shower is enough to remove the chance of getting aids.

      No amount of money from the West will solve the problem in South Africa and the rest of Africa until the governments themselves address the cultural problems.

      Until this is acknowledged, we'll be tipping money down the drain. Further, African leaders will continue to steal the money and rile against cultural imperialism to deflect from their corruption.

      Date and time
      July 06, 2010, 8:02AM
      • I have the cure! It costs nothing! It has been known and taugh for thousands of years...
        You can pour all the billions of dollars you want into condoms. THEY DONT WORK.
        Teach people self respect, explain to them how precious the gift of sexuality is. Let them learn that the sexual act belongs only in the confines of marriage and that real love waits.
        keep pushing condoms, birth control and what the demise of civilisation continue to unfold.

        In the countries like the Philipines and Uganda where they push Abstinence and Chastity the rates of STD's are far far lower than their neighbours that push condoms.

        Date and time
        July 06, 2010, 8:17AM
        • Thanks for a very interesting article showing one of the biggest issue the world is facing right now. I note that 85 countries still have laws against homosexuality. It would be interesting to know what their HIV rates are?

          Cynical observer
          Date and time
          July 06, 2010, 8:36AM
          • Great article. This needs more attention. If anyone saw the recently aired documentary on the BBC Knowledge channel by Stephen Fry on HIV you will know what I mean. There are those out there who really don't think you can get the virus from someone you trust, like your spouse, and believe it or not there are those who actually want to get the virus. The most remarkable thing is the degree of vilification that those with HIV encounter. We seem to be still very cruel and unaccepting of those with the disease, even though nearly everyone (in the West) knows you can't get it by shaking someone's hand or having them over for a cup of tea.

            Another scary thing is the existance of 'salvage' patients - those who simply do not respond to any known treatment of HIV. Don't think if you get it, the drugs will work and you will be fine. It doesn't work that way for all HIV patients and if you find yourself in that position, things are grim for you.

            Date and time
            July 06, 2010, 9:08AM
            • Good article, but it seems rather hard for Australia to do much about anything to do with this in the rest of the world! People need education and as Peter says, less criminalisation!
              To add further:
              How about we get the pope to change catholic policy on birth control also? There are many converted in Africa and especially South America, yet something so simple that can help prevent the spread of AIDS, such as the condom, is not supposed to be used by catholics!

              Date and time
              July 06, 2010, 9:12AM
              • You left something out. In Australia now the infection rate amongst heterosexuals is rising sharply. Last year new cases via heterosexual sex outstripped those via homosexual sex in 2 states - Tasmania (small close knit gay population) and Western Australia (large transient hetero/bisexual male population with ample means to pay for a 3 hr flight from Broome to Bangkok)

                Western Australia in particular seems like a brewing disaster. A lot of those guys will not get tested and they are going to go home to their wives and have babies.

                Date and time
                July 06, 2010, 9:26AM
                • Thanks for the diversion into lala land Craig - the grown-ups might continue this conversation in the real world huh.

                  Date and time
                  July 06, 2010, 9:28AM
                  • It's obvious condoms are not helping at all. With 30 years of pushing them and despite what the article above says, the infection rate is still going up according to the gentleman on the radio yesterday (I can't remember his name) who was giving a talk to a group of officials about the need for more funding.

                    Condoms are not 100% effective. Nowhere does anyone claim that they are. Then it's just down to probability. Like a casino that makes money over time, so does HIV spread through the breakages and other problems that condoms give.

                    Let's say that condoms were 95% effective. This I think is very generous. That means that they are 5% ineffective. But what no one will admit it that the 95% effectiveness is on the FIRST use only. The second time you use a condom your percentage of effectiveness is 95% of 95% which is 90.25%. Third use is 95% of that which is 85.74% and forth use is 81.45%. So after 4 uses your chances of failure are close to 1 in 5.

                    Taken further, after 13 uses of condoms, if they are 95% effective makes them about 50 - 50 chance of failure. After 13 uses the odds are against you and this is for a deadly disease with no cure. Not to mention all the other diseases out there.

                    The complacency of the message that a condom will prevent HIV is wrong and after 30 years of zillions of condoms being used, and millions more people getting infected, there has to be a different solution. One that is 100% every time. Because 100% of 100% is always 100%.

                    The only answer I can see is abstinence. You'll NEVER get HIV if you abstain.

                    Date and time
                    July 06, 2010, 9:43AM
                    • @ Craig is either a troll or terribly deluded.

                      Date and time
                      July 06, 2010, 9:54AM

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