Australia should do more to help close the HIV/AIDS gap

Bill Bowtell Executive Director Pacific Friends of the Global Fund to Fight AIDS, Tuberculosis and Malaria

19 Jul, 2016

Australia can never truly be free of AIDS, or the resurgence of new forms of HIV, until we are free of AIDS and HIV across the world, says Bill Bowtell, Executive Director, Pacific Friends of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

As the 21st International AIDS Society conference AIDS 2016 gets underway in Durban, South Africa, and amid diminishing global funding, Bowtell has called on the Australia Government to increase its funding for poorer countries still tackling HIV and AIDS.

Two significant events will take place that will affect global progress towards the eventual elimination of HIV and AIDS in coming months.

This week, the International AIDS Conference will convene for the 21st time since the emergence of the HIV/AIDS pandemic in the early 1980s, and for the second time in Durban, South Africa.

And in mid-September, Canadian Prime Minister Trudeau will chair the Replenishment Conference for the Global Fund to Fight AIDS, Tuberculosis and Malaria, a primary funder of the response to HIV/AIDS.

Durban2016 will bring together the world’s best HIV/AIDS researchers, scientists, activists and officials to consider the latest evidence of progress across HIV treatment, care, prevention and research.

Happily, the conference will hear that remarkable progress has been made and sustained in reducing the headline statistics of the HIV/AIDS pandemic.

UNAIDS has reported that the global number of new HIV infections has fallen by 38% since 2001, from 3.4m to 2.1m new cases in 2013. From a peak in 2005, AIDS deaths fell from 2.4m to 1.5m in 2013, a reduction of 35%.

These figures could not more different from those presented at the first time the International AIDS Conference was held in Durban in 2000.

Then, the rates of new HIV infection and deaths from AIDS were on a seemingly inexorable upwards trajectory, especially in the developing world and predominantly in sub-Saharan Africa.

In South Africa, for example, an estimated five million people (of a then total population of 25m) had been infected with HIV.

In many of the world’s poorest and most fragile countries, the unchecked spread of HIV/AIDS was beginning to have a clear, adverse impact not just on those individuals who had fallen ill, but on overall economic growth and development.

By 2000 it was obvious that a chasm had opened up between the impact of HIV/AIDS in developed and developing countries.

Since the first emergence of HIV/AIDS in the early 1980s richer, more organised countries broadly responded more rapidly and effectively to devise and implement effective policy measures to restrict the spread of HIV among high-risk groups and the general population.

After the introduction of the first effective HIV antiretroviral therapies (ART) in 1996, the profile of the HIV/AIDS epidemic in the developed world began to diverge rapidly and radially from that of the poorer countries.

ART treatments had a double benefit: firstly, those who went on to treatment became increasingly unlikely to develop AIDS-related illnesses. Secondly, those on HIV treatment became much less infectious and therefore much less likely to pass on HIV infection to other people.

That is, the new treatments not only had a direct “treatment” benefit for those who had HIV/AIDS, but they also engendered an indirect “prevention” benefit for those who were HIV-negative.

By Durban2000, it was blindingly obvious that wherever people had access to HIV treatments, the rates of new HIV infection would fall away considerably.

The new HIV treatments had transformed the shape of the pandemic in the rich countries but had no impact at all in Africa and the emerging economies. Intense anger and frustration at this intolerable state of affairs came to a head at the 2000 Durban AIDS Conference.

Led by then UN Secretary-General Kofi Annan, Durban2000 saw the creation of several remarkable and well-funded mechanisms aimed at financing and securing the spread of new HIV treatments to all who needed them. The US President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the injection of new funding for HIV were directly attributable to the global activism that boiled over at Durban2000.

Over the past 16 years, thanks to the weight of money being put behind strategies that work, in much of the world great progress has been made against the HIV/AIDS epidemic.

Global Fund programs alone have supported 8.1m people being placed on ART therapy and 3.1m mothers have received medications to prevent transmission of HIV to their babies. “Treatment as Prevention” has been a resounding success.

And now, scientific evidence clearly demonstrates that HIV-negative people who use anti-retroviral therapy as PrEP (Pre-exposure Prophylaxsis) will have a vanishingly low risk of acquiring HIV.

But in 2016 we are at a very serious point in the global response.

Just at the time when more money and resources should be applied to consolidate these gains, to spread access to ART and PrEP and drive down HIV infection rates aggressively, global HIV funding is diminishing.

The unintended consequence of falling HIV and AIDS indicators has been to lead many rich countries to assume that the worst is behind us, and funds can be otherwise engaged. This is, of course, extremely fatuous reasoning.

In Australia, we long ago saw the end of AIDS as a public health threat, and are well on the way to substantial reductions in our already low rate of HIV infections. But we can never truly be free of AIDS, or the resurgence of new forms of HIV, until we are free of AIDS and HIV in our region, and the world.

In developing countries, while 40% of HIV-infected people are on ART, 60% are not. It is intolerable that we do not yet have universal access to HIV treatments, let alone PrEP being made available to those at highest risk of HIV.

If we can reach universal ART coverage, the world would be well on the way to the elimination of deaths from AIDS, and, eventually the elimination of HIV altogether.

Australia and other donor countries have the long-term fate of millions of people in their hands. 

In September 2016, Prime Minister Trudeau of Canada will chair the triennial replenishment conference of the Global Fund.

Australia should increase its contribution to the Global Fund from $A200million to say $A300million for the period 2017-19.

Increased support for the Global Fund will represent a tremendous step towards the end of AIDS, and the eventual elimination of HIV.

  • Bill Bowtell Executive Director Pacific Friends of the Global Fund to Fight AIDS, Tuberculosis and Malaria
    Bill Bowtell Executive Director Pacific Friends of the Global Fund to Fight AIDS, Tuberculosis and Malaria

    Bill is a strategic policy adviser, with particular interest in national and international health policy structures and reform. As senior adviser to the Australian health minister, Bill Bowtell played a significant role in the introduction of the Medicare health insurance system in 1984. He was an architect of Australia’s successful and well-regarded response to HIV/AIDS. Between 1994 and 1996, Bill Bowtell was senior political adviser to the Prime Minister of Australia. Since 2005, Bill was Director of the HIV/AIDS Project at the Lowy Institute for International Policy and, since 2009, the Executive Director of Pacific Friends of the Global Fund funded by the Bill & Melinda Gates Foundation.

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