As HIV/AIDS hits 40, the global response has declined, resource mobilization is faltering and stigma against vulnerable populations is widespread, a World Bank official said says
"We will be living with HIV into the next century," global HIV/AIDS program director said David Wilson told the STI & HIV 2019 World Congress in Vancouver Tuesday.
The US Centre for Disease Control first described the disease in June 1981. A journal article discussed a lung infection among previously healthy gay men whose immune systems had stopped working.
He said in countries such as Australia with AIDS contained to certain communities, the epidemic may be ended locally. In a city such as Vancouver, however, he said, it exists across multiple communities such as the gay and IV drug using communities and may be harder to control.
He said the response to HIV/AIDS globally has been uncertain since the epidemic entered its third phase in 2012.
"Advocacy-based claims that we can end the HIV epidemic are premature and have contributed to a perception that the crisis is largely over," Wilson's presentation abstract said.
The former University of Zimbabwe professor called the first phase – from the early Eighties until the late Nineties, as an era of despair as the HIV virus raged unchecked through communities – including Vancouver. Political and resource commitment were scare, he said.
That phase, he said, saw the virus "scythe through the gay community and rampage like wildfire through African nations.
He called them years of denial and impotent government responses that led to the deaths of more than 30 million people.
He said the turning point in the fight against HIV/AIDS was the 1996 International AIDS conference in Vancouver.
The second phase – from the early 2000s to 2012, Wilson called a period of hope with treatments being developed and political commitment and international resources surging.
Now, he said, the global response is uncertain with other diseases such as tuberculosis, malaria and hepatitis competing for a share of a funding pie that isn't growing.
"We encourage a global HIV response," Wilson said. "Will it be planned and managed or will it be a train wreck?"
He characterized the phases as calamity, hope and choice.
And, he said, that choice has resulted in more than 23 million people now being treated worldwide.
There are, however, problems in global response. Wilson said rich countries can fund a response and poor ones are eligible for international assistance.
"It's the ones in the middle we need to worry about," Wilson said.
Further, he said some countries do not see their health ministries as efficient spenders of funds and therefore do not fund them as needed. And, he said, other government agencies need to coordinate to foster health outcomes. He said literacy from education would assist in good health.
"Half of the world's children leave school unable to read or write," he said. "If we can start to reverse that process . . ., there will be important benefits for health.
But, Wilson, getting there is the hard part.
He said response planning and budgets need to be integrated across governments.
And, he added, other countries need to step up to the plate to assist the United States, which provides the bulk of international AIDS financing.
He called the dependence perilous.
Countries have also suffered from a consuming focus on HIV, Wilson said. He explained that with one disease taking the spotlight, others flourish in the resulting darkness and are displaced from health services.
Reporter Jeremy Hainsworth can be reached at jhainsworth@glaciermedia.ca
