Q&A: “Less Funding Could Lead to Millions of AIDS Deaths”

Thalif Deen interviews BERTIL LINDBLAD, director, UNAIDS Office in New York

UNITED NATIONS, Nov 28 2008 (IPS) – The global economic crisis is threatening to undermine yet another key development goal set by the United Nations: reversing by 2015 the AIDS epidemic still devastating millions of people worldwide.

Bertil Lindblad Credit: UN Photo

The continued refrain that there is too much money for AIDS is misleading, says Dr. Peter Piot, executive director of the Geneva-based UNAIDS. The sobering reality is that the AIDS response remains under funded.

Last year, there were substantial increases in resources to battle HIV/AIDS worldwide, which totaled 10 billion dollars a 12 percent increase over 2006 and a 10-fold increase in less than a decade.

But still there was a shortfall of over 8.1 billion dollars last year. The gap in 2008 could be wider.

Speaking on the eve of World AIDS Day on Dec. 1, Piot says the global financial crisis could lead to funding cutbacks, which in turn, will have harmful impacts throughout the developing world generally, and in the AIDS response in particular.

As updated last week, some of the global facts and figures on AIDS read: an estimated 33.0 million people living with HIV worldwide; 2.7 million people newly infected in 2007; and 2.0 million who died of AIDS in 2007.
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The epidemic is still running ahead of the response, Bertil Lindblad, director of the UNAIDS Office in New York, told IPS U.N. Bureau Chief Thalif Deen.

It is a long enduring epidemic and we need sustainability in the response, he added.

But this new phase poses major challenges too: to sustain this momentum into the future and to build upon it to ensure that we are in a position to provide the best possible results for people not just today, but in 20 to 30 years time from now.

Excerpts from the interview with Lindblad follow.

IPS: Despite a six-fold increase in financing for HIV programmes in low- and middle-income countries, there were still about 33 million people worldwide living with HIV infections last year and 2.7 million with new infections. How do you see the global situation today? BL: AIDS is one of the defining issues of our time; it remains true today and will remain a priority right through the 21st century. For AIDS, like climate change, is a long wave, geopolitical event that has global impact. We are now entering into a new phase in the response to AIDS. It is for the first time that the AIDS response is producing real results.

Progress has been recorded in a substantial increase in HIV prevention and treatment efforts, especially in a number of heavily affected countries. Today, well over 3.0 million people in low and middle-income countries have access to life-lengthening HIV drugs.

The UNAIDS 2008 Global Report shows that new infections have declined from 3.0 million to 2.7 million in 2007. One reason for this is that people in many countries are beginning to change their sexual behaviour- waiting longer before having sex, having fewer sexual partners and using condoms when they do. Fewer children were born with HIV too. Some 33 percent of women who need services to prevent transmission of HIV to their children can now obtain them.

This is just the beginning. However, while the global epidemic has leveled off in terms of the percentage of people infected (prevalence), the total number of people living with HIV has increased to 33 million people globally, with nearly 7,500 new infections each day.

The AIDS epidemic is not over in any part of the world: there are still five new infections for every two people newly on treatment. In addition, we are seeing a rise in new HIV infections in some older epidemics, as noted in countries, such a Germany, England and Australia.

IPS: The Millennium Development Goals (MDGs) one of the U.N. s highest priorities call for a reversal of the AIDS epidemic by 2015. Secretary-General Ban Ki-moon has warned that the current global financial crisis threatens to undermine all of the MDGs. Will the financial crisis also have an impact on the fight against AIDS? BL: The toll of funding shortages will be unacceptable without treatment. It could lead to the death of millions in the next few years, while a setback in HIV prevention will result in increased costs later as more people will become infected. It is critical to maintain the full commitment of donors and national governments to sustain and expand these efforts. Failure to do so would be disastrous for millions of people. It would seriously negate the enormous investments that have been made and hamper the momentum of realising the MDGs by the target date of 2015.

In times of funding constraints, greater efficiency and enhanced delivery of programmes is more critical than ever. Full implementation of the 2005 Paris Declaration on AID Effectiveness both by donor and recipient governments is essential.

IPS: Women account for half of all the HIV infections worldwide over the last few years. Why is progress so slow? Is it financial, political or cultural? BL: HIV continues to spread and its impact continues to intensify, especially among women. This is due to the deep underlying factors of gender inequality, persistent stigma and discrimination against women and girls, and lack of empowerment to reduce their vulnerabilities to HIV.

The social, cultural and economic factors that make women vulnerable to HIV and disproportionately burden them with the epidemics impact (particularly in the area of care) are major impediments to national AIDS responses.

IPS: Despite a vigorous campaign by the United Nations, there is still a widespread social stigma attached to AIDS since most countries lack laws protecting people living with HIV. Where are the successes and failures in anti-discrimination legislation worldwide? BL: A large majority of countries 67 percent report that laws and regulations are in place to protect people living with HIV from discrimination. For example, the Namibian Parliament included HIV as a prohibited basis for discrimination in the country s Labour Bill passed in 2007.

Laws in the Bahamas, Malawi, South Africa and Zimbabwe disallow mandatory HIV testing as a condition of private employment. Cambodia, Guyana and other countries have legislation specifying the right of people living with HIV to equal access to high-quality health care.

However, the degree to which these laws are enforced has not been documented. In addition, at the June 2008 High Level Meeting on AIDS, U.N. member states were called on to remove travel restrictions placed on people living with HIV, by the U.N. secretary-general and others. Sixty-three countries still have laws that impose some form of restriction on the entry, stay and residence based on HIV status alone.

Eight countries declare all people living with HIV inadmissible for any reason or length of time; with an additional five countries denying visas for even short-term stays. Twenty-eight countries deport individuals once their HIV-positive status is discovered.