Tuesday, November 29, 2011
The Global Fund for AIDS, TB and Malaria has dried up. Perhaps not for ever, but for long enough for us to realize that providing increasing numbers of people with increasingly expensive drugs for decades may not be wholly sustainable.
If any effort had been made to reduce transmission of HIV (or even TB or malaria, although they do seem like a bit of an afterthought) over the last 10 years, the costs of 'universal access' to antiretroviral drugs might have gradually become achieveable. But with more people being infected than being put on drugs, the Fund has presided over ten more years of missed opportunities in the field of HIV prevention.
There's lots of talk about treatment being prevention, on the grounds that those on treatment are less likely to transmit HIV. But that is still just talk, and the levels of testing, treatment, support and monitoring required to effect such a program are probably beyond the means of all HIV funding put together. Treatment is vital, and greater access to treatment may help prevent some infections, but it will never obviate the need for effective prevention strategies.
So Kenya is being advised to "Seek Alternative Ways of Funding Healthcare", as no new programs will be funded for the next two years. Ten years of ignoring health systems and diseases that were not considered sexy enough now means there is a lot of catching up to do and no money to do it with. For all the billions that have gone into HIV, African health systems have little to show for it. It's late in the day for a decision to start to see HIV for what it is, a disease, one among many. It's also late to decide that "it is time to dismantle the many parallel HIV programmes created mainly to compete for donor funding but which are unsustainable".
Uganda finds that the "Aid Cut [will] Affect One Million HIV Positive Citizens". Apparently the country had massive plans to eradicate HIV, even more massive than the ones that didn't eradicate it over the last twenty years. There were plans to put most people on treatment, especially mothers and children. But the virus appears to be making a comeback in certain sectors of the population, and has been doing so for some years. Exactly what have they been doing?
The Ugandan Government is also "Advised to Use Local Resources to Fight Aids", which would probably be good advice if such local resources exist. But African governments might also be well advised to form their own health strategies, with HIV fitting appropriately into those strategies, rather than remaining apart from health and other social services and completely dominating most agenda, as it has done for so many years. The various organizations and institutions that have been sucking on the HIV nipple will need to diversify, downsize or disappear.
None of this sounds like a reason to celebrate. But it is a good time to change, if African governments decide to do so. It may now be up to them to identify the main drivers of the virus, to assess the relative contribution of each mode of transmission and to decide on the most appropriate ways of preventing the further spread of HIV. If the donor community is no longer paying, perhaps Africans will notice that their sexual behavior is not that different from that of non-Africans. Perhaps the way will be open for programs that rely less on expensive technologies and an unwarranted assumption that HIV transmission all a matter of sex.
Because currently, things are great for the pharmaceutical industry and the HIV industry in general. Not without some serious lobbying, I'm sure, but everything has been going their way for years. Donor funding has poured into their coffers and every year a new scheme is dreamed up to increase the tonnage of drugs shipped to poor countries, where far more people are dying for lack of clean water and decent levels of nutrition than HIV.
Perhaps now, the 'experts', the ones that African countries couldn't do without, will have to go home and find a job in healthcare, with the appropriate retraining, of course. I believe it's called 'task shifting'. Africans will not suddenly start losing out as a result of Global Fund cuts, they have been losing out for years. But the HIV industry will lose out. Expect a lot of emotive pleas, ostensibly for 'dying Africans', but hear those pleas for what they really are: self interest.