International Policy Network Partly Right and Partly Wrong About HIV/Aids

Philip Stevens of the International Policy Network questions the wisdom of spending so much money on a single illness, HIV/Aids, and asks if this can do more harm than good. I have long been asking the same question. My feelings are that it has done very little good and has probably done a lot of harm, especially to HIV prevention efforts.

The health of a nation is unlikely to be made or broken by one, single health condition. Even when there is a serious epidemic, there are probably always more people suffering from and dying from ordinary, every day things than from that epidemic disease. Health depends on people's lifestyles, living conditions, levels of nutrition and food security, education and economic circumstances, for example.

Stevens rightly criticizes UNAIDS's prioritization of treatment over prevention. Since treatments for HIV have been developed, far more money has always been spent on that than on prevention. So while many have been treated, millions more have become infected. Greater emphasis on prevention could have made a lot of difference, although precious few effective prevention interventions have been developed and implemented in any high HIV prevalence countries.

Stevens also mentions the poor and declining state of health infrastructure in high HIV prevalence countries. Indeed, some of the major funding bodies involved in pouring money into HIV treatment and care (and a little prevention) were, at the same time, urging developing countries to reduce spending on health, education and other social services.

If it is the case that some parties have claimed that everyone in the world is at equal risk of becoming infected with HIV, then this is truly shameful. I think the message was that every sexually active person is at risk, which is true. But it is not true that everyone faces equal risk. Perhaps this message has been confused by publicists, politicians, church leaders and various money grabbers who knew nothing about health, least of all HIV, but still wanted to get on the bandwaggon for their own ends.

And Stevens is wrong to claim that UNAIDS exaggerated the numbers of people infected and were 'embarrassingly forced to revise down the estimates for dozens of countries'. Methods of estimating numbers were improved, that's why the figures went down. Many figures are still very doubtful in that they could be higher or lower than presently estimated. Kenya was one of the countries for whom figures were revised down. A short time later they had to be revised up again.

Stephens' analysis, I think, is misleading. He makes it sound as if HIV/Aids is still a problem, but less of a problem that it was. I disagree. I believe that we neither have enough data to support his view nor directly to refute it. But there is plenty of evidence that people in high HIV prevalence countries still face serious and perhaps increasing risk of becoming infected.

I hope Stevens is right that donors have finally realized the folly of directing so much money towards one disease. However, I don't think he is right. I think he has allowed himself to be fooled by all the rhetoric about strengthening primary health care and health systems. If that is ever going to happen, I'll believe it when I see it.