Towards an AIDS-free world

Another World AIDS Day has gone by. This year's theme was "Getting to Zero" which focused on eliminating new HIV infections and AIDS-related deaths, as well as discrimination against people with the disease.

There was a lot of fanfare, many awareness programs, sponsored walks, TV programs and a whole host of other activities. This year's AIDS Day was also significant because the disease was first identified 30 years ago in the U.S.

Thirty years hence, we have learned a lot about the disease. The disease is still incurable - but not untreatable. Thus getting HIV/AIDS is no longer an automatic death sentence. AIDS sufferers can live almost normal lives on anti-retroviral (ARV) drugs. Moreover, someone who is on a standard combination of three ARV drugs is 96 per cent less likely to transmit it to a partner.

This is a grounbreaking discovery that offers a ray of hope for controlling the spread of HIV/AIDS. These two aspects have made living with HIV a lot safer.

In fact, in the developed world, the availability of drugs has made a vast difference. But millions of sufferers in the developing world do not have regular access to the drugs, even to the generic versions which are supposed to be cheap and widely available. This status quo has to change. (Six million people in the developing world should be on HIV drugs). There are 34 million people (half of them women) living with HIV around the world. Nearly 1.8 million people died of complications arising from AIDS last year and the total tally so far since 1981 is 25 million. Globally, nearly three million people are infected with HIV each year, yet only a third of those in poor countries who need treatment have access to it. According to a 2010 United Nations report, fewer than 40 percent of those needing life-saving treatment in sub-Saharan Africa, the epicentre of the pandemic, have access to ARV therapy.

Although US Secretary of State Hillary Clinton recently said the US would lead the world towards the goal of "an AIDS-free generation" the picture is not that rosy. The Global Fund to Fight AIDS, Tuberculosis and Malaria, launched by the former UN secretary general Kofi Annan a decade ago, has cancelled its next funding round.

There is not enough cash in the Fund. A year ago, when the fund asked for U$20 billion, donors managed to raise only $12 billion and there has been no increase since. (Just compare this with the US$ 1,000 billion plus collective annual military budget of rich nations). With most Western governments having enough trouble with their domestic economies, funding AIDS research has been relegated to the backburner.

It is vital for both developed and developing countries to revive this Fund. In a statement to commemorate World AIDS Day on Thursday, UN Secretary General Ban ki Moon urged international donors to meet the estimated $24 billion needed annually to fully fund global AIDS initiatives. The Fund has already done a lot of things, but more can be done. Malawi is a great example.

More than 90% of its funding came from the Global Fund and it has managed to put 76% of all those who need it on treatment.

It even wants to start all pregnant women on drugs for life, instead of offering them a short course around childbirth. Unfortunately, Malawi's grant application was turned down last year.

There will be no grant approval next year as well. But this is a dangerous move, because the people already on drugs must stay on them. Otherwise, their virus will become resistant and they will need even more powerful and more expensive drugs to live a few years more.

It is not too late for nations of the world to get together to revive fund and turn the tide to reverse the spectre of AIDS. In July 2012, the world's largest AIDS conference, to be held in the US, will focus on the theme, "Turning the tide together". It could not be more timely.

Although there has been a 21 per cent reduction in the spread of HIV/AIDS since 1997, more action has to be taken. The hunt for an AIDS vaccine must continue. Drugs companies and universities around the world are trying to perfect a vaccine and there could be an effective one hopefully in a decade.

Another approach, now being tested in mice, is injecting a 'protective gene' that would stop HIV in the first place. The researchers have sought approval for human trials. This would also negate the need for a vaccine.

One other step that can be taken at personal level is creating awareness on living with HIV and living with persons having HIV.

There is a still a great deal of stigma associated with the disease especially in the developing world. Would you work with someone having HIV ? Would you invite him or her over to dinner? Although it has been proven beyond any doubt that casual contact does not spread AIDS, most people would be reluctant to associate with a person having HIV/AIDS. 'Coming out' with HIV/AIDS has also posed a problem for many people.

If you suddenly disclosed you had HIV, would your employer fire you, even though it is unethical ? These are moral dilemmas that had stirred a lengthy debate. Removing the stigma associated with HIV/AIDS is thus essential to ensure equality for all HIV/AIDS sufferers who should not be shunned.

Sri Lanka has never experienced an AIDS pandemic, but more awareness should be created especially among the younger generation on AIDS prevention. Most youngsters lack access to sex education. Correcting this anomaly is the first step towards an AIDS-free society, not only here but anywhere else.

Prevention is always better than cure, though a cure or vaccine for AIDS is the ultimate aim of scientists. In the meantime, more funds should be made available for the procurement of pharmaceuticals and research. After 30 long years, there are still some lessons we are yet to learn.