Don’t forget about AIDS – The future of the pandemic is in our hands
Kristina Bolme Kühn, president of Doctors Without Borders in Sweden. Photo: Jonas BorgThe Human Immunodeficiency Virus was discovered in 1981, and since then over 21 million people have lost their lives due to AIDS and related diseases. In the western world, treatment with antiretroviral drugs have reduced the spread and severity of disease, but in Sub-Saharan Africa, the pandemic continues to hinder economical, social and political development. While much is still yet to be done to stop the pandemic, the financial crisis and declining public interest in the issue are leading to decreased funding at a time when it is most needed.
Kristina Bolme Kühn is the president of Doctors Without Borders (Médecins Sans Frontières, MSF) in Sweden. She has a long history of working with HIV in Africa. In her recent UPF lecture, ”HIV in a Humanitarian Perspective”, she described how the MSF went from being a purely emergency relief-based medical organization to tackling the pandemic of untreatable HIV-infections:
“We simply defined HIV as a medical catastrophe, and so, MSF automatically had a mandate to deal with this problem. People are dying of AIDS related diseases all the time, so it would be inhuman not to act!”
MSF currently treats more than 170,000 people in 19 countries, relying to about 90% on private donors for their activity.
“The major obstacle right now is not primarily a lack of money in the world but a gap of adequate funding for HIV treatment. This is especially frustrating since in many of the countries with high HIV/AIDS prevalence there is lots of knowledge and preparedness to roll out treatment programs, however given the global financial recession funding has slowed down or even been stopped. The Global Fund to Fight AIDS, Tuberculosis and Malaria, a financial aid organization and UNAIDS, the UN programme on HIV/AIDS treatment, have been facing major cuts in funding from donor countries in the last three years. Many countries (including Sweden) donate money to these large organizations, but the money may not reach all the way!”
In spite of the above, Kristina Bolme Kühn firmly states that it is highly possible to eradicate AIDS through a combination of prevention and treatment.
“It is time to act now, when the infrastructure is strong! This is backed by UNAIDS that has stated that the world could see a decline in the spread of the virus within the next few years”, she says.
Anders Nordström, the ambassador for Global Health issues at the swedish foreign ministry is of a different opinion:
“The pandemic would have been possible to stop if sufficiently aggressive action would have been taken early on, but I don’t think it is realistic to eradicate AIDS today. Attitudes and values are standing in the way of eradicating the pandemic in the near future.”
Nordström’s area of responsibility was just recently changed from HIV/AIDS to the more general term Global Health, which is a reflection of the change of perspective in foreign aid politics in Sweden and globally:
Anders Nordström, the ambassador for Global Health. Photo: WHO. “Specifically children’s and mother’s health and life style-diseases are becoming increasingly important, when even in South Africa, where AIDS is highly prevalent, cancers, diabetes and coronary heart diseases are rapidly increasing”, he says.
However, Nordström doesn’t see this shift of focus as particularly problematic:
“We don’t really have a problem as long as the priority for health remains. The health infrastructures that are supported by foreign aid will often be able to treat and prevent both HIV/AIDS and most other illnesses.”
“The role of the Swedish governmental development co-operation is similar to that of most other governments , being primarily a provider of financial support (about 4 billion SEK/year to health), relying on the implementation by other organizations, the Global Fund and George W Bush’s President’s Emergency Plan For AIDS Relief (PEPFAR). Further, as opposed to NGOs such as the MSF, states often use political pressure as a means of achieving change.”
To Anders Nordström, the political aspect of foreign aid is only rational:
“All is politics. Health is politics. In working closely with politicians I have come to realize the rationalism of politics and how important political mobilization is for improving people’s health. The focus of Swedish foreign aid depends on what voters want, which makes public opinion very important.”
At Médecins Sans Frontières this development is perceived as highly troubling:
“People often tell us that we are dreamers when we say that AIDS can be eradicated”, Kristina Bolme Kühn says. “Lately we have seen a declining interest in and knowledge about HIV/AIDS. People must engage themselves both by giving money and by affecting the politicians to continue supporting the fight against HIV/AIDS.”
“Sure, both funding and implementation must function perfectly, but with these components in place, we are looking at a future without AIDS”, Kristina Bolme Kühn concludes.
The Human Immunodeficiency Virus (HIV) is a so-called retrovirus. It spreads through bodily fluids (blood, semen, vaginal fluid, or breast milk), infecting human immune cells. The death of certain of these defense cells leads to an Acquired Immunodeficiency Syndrome (AIDS). The immune deficiency in individuals with AIDS leads to a very high risk of infections from a number of organisms as well as some forms of cancer.
Due to a high rate of mutation of the HIV-virus, vaccines have not yet been successful. Anti-retroviral treatment (ARV) is currently the most powerful weapon against the virus, striking at several levels of the HIV-virus life cycle. A successful ARV-treatment prevents the virus from replicating, and thus AIDS fails to develop. Also, ARV may decrease the viral load to levels where it is hardly contagious. Effective HIV-prevention programs include the ABC approach (Abstention, Be faithful, use Condoms) and education.