Every year since 1988 the joyful tidings of Christmas have been preceded by the increasingly upbeat message of World AIDS Day, December 1. This year’s theme of “Getting to zero” was launched last month by Hillary Clinton announcing that an “AIDS-free generation” was within grasp if the United States and countries around the world would team up on scientific advancements. President Obama threw an extra $50 million in that direction and he was joined by former presidents George W Bush and Bill Clinton in promising greater commitment to eradicating the disease. The catch-line, “beginning of the end”, was scripted in the White House. Bono, Elton John and Carla Bruni-Sarkozy leant their faces to the cause.
Unfortunately, the promotion seems to have fallen flat. Pleading financial crisis, the governments that are the mainstay of the Global Fund to Fight AIDS, TB and Malaria (US$21.7 billion pledged last year) have decided to cancel the next funding round and no new applications will be accepted until 2014. This certainly is tragic, since the Global Fund keeps alive nearly half (3.2 million) of the 6.6 million people living on life-saving antiretroviral (ARV) drugs, and efforts to prevent mother-to-child transmission are said to have some success. Progress has also been made against the other big epidemics. However, there are still 7.6 million people who need ARV treatment, and many of those are now unlikely to get it.
But even without the defection of the cash-strapped rich countries there was always going to be bad news to report. AIDS might be on the decline, thanks to treatment, but HIV infections are on the rise again after falling for several years. About 2.7 million people were infected last year, which is double the number brought into treatment, according to The Independent, and people are now becoming infected faster than they can be tested and treated. In Malawi, a small African country with a population of under 15 million, 70,000 new infections are expected next year.
The truth is that there can never be enough billions to “end” an epidemic driven by the sexual ideology of the same parties -- or their partners -- that are supposed to be curing it. This was rather sharply illustrated a couple of months ago with the publication of evidence linking the widespread use of progestin injections as birth control with HIV transmission in sub-Saharan Africa. But even without such a direct channel, the “sex positive” approach of the family planning networks in developing countries guarantees that the behaviour basically responsible for disease -- having multiple sex partners -- does not change.
It is no accident, then, that this week thousands of experts and acolytes are gathered in Senegal for the second International Conference on Family Planning to push forward the global family planning agenda. They too will be demanding billions from the first world’s governments and foundations. The director of the Gates Institute for Population and Reproductive Health, Dr Amy Tsui, who is also a professor at the Johns Hopkins Bloomberg School of Public Health, is a lead conference organizer.
One of the things they are talking about at the ICFP conference is, according to one report, “the prevention of HIV through multi-prevention technologies (MPTs) that protect against HIV and act as contraceptives”. They don’t have these MPTs yet, you understand, but they are working on them -- for instance, a vaginal ring that releases both an ARV drug and a contraceptive hormone. What it would cost to provide such technology to African women is anybody’s guess. In the meantime what they have, mainly, is the contraceptive injection, and the condom. One seems to be contributing to the HIV epidemic and the other has never stopped it.
What has shown the potential to stop the epidemic is well known: behaviour change strategies used in Uganda and (less famously) in Zimbabwe. Uganda turned its epidemic around in the early 1990s with its ABC programme focusing on abstinence for the unmarried and “zero grazing” for the rest. This has since been undermined by aid organizations pushing condoms. Zimbabwe in the ten years to 2007 brought its HIV prevalence down from 27 per cent to 16 per cent -- mainly, according to researchers, through reductions in extramarital, commercial, and casual sexual relations”.
Edward Green, the Harvard researcher, who stumbled upon Uganda’s secret in 1993 has been trying ever since to get recognition for behavior change as the most effective means of dealing with the AIDS epidemic. In his recent book, Broken Promises: How the AIDS Establishment has Betrayed the Developing World (2011), he recounts how, at an AIDS conference in Washington in 2004 his presentation received muted applause. But, when a female college student came to the microphone and exclaimed, “I think people should be able to have as much sex as they want, with as many people as they want,” she received a thunderous, standing ovation.
That is what the people of Africa and elsewhere are up against: not only a deadly disease but an international community that has such an investment in its own doctrines about sex and population that it will use all its political and economic power to impose them where they are most destructive. Already in Africa alone more than 46 million people have been infected with HIV and 18 million have died.
The developed nations should be ashamed to stage another World AIDS Day, let alone project its end, until our responsibility for this avoidable epidemic is admitted.
Carolyn Moynihan is deputy editor of MercatorNet.