A Global Test of Willpower

The official logo of this summer’s biannual International AIDS Conference, which convenes today in Bangkok, Thailand, depicts three elephants walking forward together. They are intended to illustrate the conference’s theme of “Access for All,” to symbolize how communities, families and HIV/AIDS workers have successfully joined forces in the fight against AIDS.

Nothing could be further from the truth. In fact, the main lesson of this conference is that the world’s response to HIV/AIDS continues to be woefully inadequate, bringing into sharp relief everything that is wrong with the world -- and pointing out that our leaders are not sufficiently serious about correcting those wrongs.

It’s true that many people in the United States can get the pills that fight HIV and prolong their lives. But it’s important to remember that we still don’t have anything that cures the disease. And those with access to medication tend to be people who are employed and have insurance that foots the bill for top-notch medical care and for the expensive medications they take every day.

That’s not the case for everyone in the United States. Those who are uninsured or African American or Latino or dependent on Medi-Cal are less likely to get treatment. If they do receive medical care, it is less likely to be up to acceptable standards. The uninsured die sooner from HIV/AIDS than people with insurance. And people from poor and minority communities acquire HIV at higher rates than those who are white, affluent and insured. Where are the families and communities joining together to make sure that everyone in the U.S. has access to the same prevention techniques, drugs and standards of care?

And then there’s the rest of the world. Last week, UNAIDS announced its new statistics for worldwide infections. It calculated that about 5 million people acquired HIV last year. Some have quibbled with the statistics, and the true number may be 3 million or 4 million or something in between. But even if you take the lowest estimate, 3 million new infections in a year translates into 8,200 infections a day or 342 infections in an hour. Given that HIV is lethal in about 99% of the people it infects if left untreated, that is the equivalent of a Boeing 747 crashing every hour of every day for a year.

A 747 going down is a largely preventable catastrophe. But so are most HIV infections if we really devoted ourselves to prevention. The Kaiser Family Foundation has found that we are spending only about 25% of what is needed on this epidemic, not nearly enough even to keep up with it. The Bill and Melinda Gates Foundation has documented that worldwide only 10% to 20% of individuals who need them have access to proven prevention technologies (like condoms) and fewer than 7% have access to life-extending medications. It does not need to be this bad.

There are those who say that we’re moving in the right direction, that the President’s Emergency Plan for AIDS Relief, or PEPFAR, the 3 by 5 program (3 million people on drugs for HIV by 2005), and the Global Fund to Fight AIDS, Tuberculosis, and Malaria are great strides forward. But those programs are better in theory than practice. PEPFAR is underfunded, covers only 15 countries and requires that recipient countries agree to prevention standards that have been proved scientifically to be useless. The World Health Organization does not have the funds to implement the 3 by 5 target and thus will fall short of its goal. Likewise, the Global Fund is already behind in what it needs and will fall terribly short of its potential in the next few years.

The leadership of the developing world cannot be exonerated either. Thaksin Shinawatra, the prime minister of Thailand, invited the leaders of nine countries and the European Commission to come to Thailand for a “Leadership Conference.” Only one, President Yoweri Museveni of Uganda, accepted. President Thabo Mbeki of South Africa had the chance to lead Africa out of the AIDS epidemic just as Mandela led his country out of apartheid. He chose, instead, to argue about the causes of HIV rather than plunge into distributing medications to those who needed them.

HIV/AIDS points its finger at all that is wrong with the way we do things in this world. People are allowed to catch a totally preventable disease because we will not deploy readily available prevention resources. In some cases, the reasons are ideological. In other cases, they are financial. Either way, infections that could have been prevented are increasing and people are dying as a result.

My friends and colleagues will tell you that I’m an incurable optimist. I have been battling HIV -- both personally and professionally -- since the epidemic began. I do not intend to stop. It is important that we -- and I mean all of us -- keep trying to improve our scientific understanding of the virus and find better ways to stop it. And it is equally important that all of us in the developed and developing world continue to try to convince our policymakers that their priorities result in unnecessary deaths every day, every hour.

Morality is often invoked as a reason not to employ proven prevention strategies like providing condoms for young people or clean needles for drug users. No one can invoke the moral high ground if they permit unnecessary infections and deaths to occur. Let’s devote the resources and energy necessary to prevent -- and ultimately to cure -- HIV, so that someone writing about this epidemic 100 years from now won’t simply conclude that we lacked the will to attack the problem.