Debate Is Profoundly Unhelpful And Distracting says Rachel Baggely. 27/10/09

Dear Friends

This 'we are spending too much on HIV' argument has frequently been made over the past 5 years and has been repeatedly challenged by many. 

 It is true that over the past 20 years there has been a considerable increase in funding for HIV prevention and care - to amazing benefit to millions.  It is quite incredible that 30 years after the first cases of AIDS were seen and when we knew nothing about HIV we now have:

1. An effective HIV diagnostic test that can give a reliable result in a few moments for less than £1

2. An identified virus whose genome is mapped, whose transmission modes and replication is fully understood that has been shown to cause immunosuppression that leads to 'AIDS'

3. Amazingly effective treatment - HIV has become a manageable condition like diabetes or hypertension - if you take the daily medication you can live a long and healthy life  and the cost of this medication has fallen from £1000 a month 10 years ago to £10 today .  More than 3 million people in poor countries are on antiretroviral treatment - the majority are young productive individuals who without treatment would be dead, often leaving behind children and other dependents.

4.  A hugely impressive body of information and evidence about effective HIV prevention

·         we can now prevent almost all transmission of HIV from mothers to children

·         we can make injecting drug use safe - both in clinical settings and for people who inject drugs but making sure that clean needles and sterile medical equipment is available and substitution therapy is available for drug users

·         we have a range of methods to prevent the sexual transmission of HIV - for example high quality HIV education programmes for young people that enable young girls in particular to delay sexual debut and those who chose to have sex provision of male and female condoms.

 All these prevention interventions have had a truly remarkable impact in many many countries - particularly across Africa - where prevalence rates are levelling off  - and falling, particularly in Southern and Eastern Africa.  This will translate into many many millions of infections (and hence lives) saved.

5. Benefits beyond HIV.  the dynamism and activism of so many brave people - often living themselves with HIV - has been at the forefront of these impressive developments.  Antiretroviral drug prices reductions and roll out to developing countries would never happened without global lobbying.  but this lobbying has also extended to other diseases of poverty - HIV activism inspired a huge push to increase funding and effective responses for TB, malaria and childhood infections such as pneumonia and meningitis which are now prevented by infant vaccination programmes. 

Furthermore the huge increase in funding for these infections has had a much wider benefit to improving general health and heath care systems in poor countries.  When a nurse is trained in HIV and counselling skills she/he will provide better overall care and have better communication skills.  the hundreds of thousands of home based care volunteers trained originally to support people with HIV have had a much wider impact than just caring for people with HIV.  many of the CA funded programmes such as our CBCO programme than supports 40,000 children affected by HIV and their families concentrates on economic strengthening of the whole household with educational, nutritional, economic and social benefits as key measurable impacts.

It is very disingenuous of the anti-HIV funding lobby to claim that HIV money is diverting money from other causes - much of the funding has indeed been additional new funding and in the grand scheme of things this funding still remains miniscule compared with funding so effortlessly found to fund bank failures and futile wars. it would be better to applaud the way that HIV programmes have risen to - what at the time seemed impossible  - challenges (no one would have believed 10 years ago that there would be >3 million people on ART in poor countries and that we really could start to reverse the HIV epidemic across Africa ) and learn from this effective evidence-based approaches that have truly cost-effective life-saving benefits. 

So this debate is profoundly unhelpful and distracting.  We must celebrate the successes of the past decade - but realise we must advocate for continuation of this work as well as finding additional funding for other neglected developmental problems - such as clean water and diarrhoeal diseases as mentioned below. 

Rachel Baggaley

Christian AID