World AIDS Day – 30 Years On

December 1st, 2011 marks World AIDS Day, and this year marks 30 years since the first case of AIDS was diagnosed.

Usually World AIDS Day is a time when the global community celebrates living positively, increased testing, increased enrollments, strengthening ARV access in rural areas, and emerging research, etc.

World AIDS Day YAY

Unfortunately, this World AIDS Day also brings tidings of shock and dismay amongst many in the humanitarian field, as just a week ago, the Global Fund (which pays for about half the AIDS drugs for people in poor counties, has funded 8.2m courses of TB treatment and distributed 190m mosquito nets) announced it was canceling it’s next round of grants (round 11) until 2013.

So what, it’s just more funding being frozen in the aid world, right? Nothing new, right? Just another two years to wait? Wrong. In South Sudan (and in other countries), what it means is that for the majority of people, if you are not currently – right this minute – on ARV treatment, you won’t be able to be on it until at least 2014.

This is not hyperbole. This is fact.

Or in the much more eloquent words of Stephen Lewis:

The Global Fund to Fight AIDS, Tuberculosis and Malaria has been the international financial armada in the battle against the three diseases. The collapse of the next round of Global Fund grants, known as Round 11, is the most serious, catastrophic setback in the Fund’s decade of existence. Hiding behind the banner of the financial crisis, the donor countries have clearly decided that if budgetary cuts are to be made, the Global Fund can be among the first to go.

It’s terribly important to recognize the moral implications. It’s not just the fact that people will die; it’s the fact that those who have made the decision know that people will die.

What this means is that there are 4,000 people enrolled on treatment in South Sudan.  It is estimated that at least 49,000 more people need to be enrolled on treatment (and estimated total number of infected people is somewhere around 300,000-ish).

And47% of women in South Sudan have never heard of HIV or AIDS. And more than 350,000 people have returned to the country in the past 12 months alone, mostly from countries of higher prevalence. And polygamy is common, accepted, and often encouraged. And the sex trade is growing (particularly with women from Uganda and DRC who were lured to Juba with the promise of nonexistent jobs). A perfect storm for an HIV explosion is brewing.

And now, drugs will run out in Feb 2012.  And no new enrollments until at least 2014. And try as they might to stopgap, the government and MOH here simply don’t have the resources to step in and play hero completely. And South Sudan is just one example, one small microcosm of people who were counting on this money.  So in the words of Stephen Lewis, again:

It’s hard to find the words to characterize what the cancellation of Round 11 will mean. Quite simply, without adornment, people will die in large numbers. The Fund will attempt to sustain the programs presently in place, but the opportunity to enroll others who need treatment—and that number is 7.6 million—will be lost.

Curiously, unconscionably, there are voices from whom we have not yet heard, but should have heard the moment the ugly decision was made. Where is the leadership of the United Nations in the wake of the dismantling of the Global Fund? Why hasn’t a press conference been called, led by the Secretary-General, to denounce the donor decision and to demand a reversal?

This is 1,000 people on treatment in Tambura (in Western Equatoria, which borders DRC and CAR and has a prevalence of 7%) bringing their relatives, spouses, neighbors for treatment and not being able to get drugs. This is the global community throwing their hands up and saying “Well, we’ve come this far, so… meh. Just hang tight for a few years.”

World AIDS Day... yay?

South Sudan, as a new country, changing and evolving at the speed of a freight train, is on the brink of an HIV explosion. The defunding of the Global Fund is a recipe for disaster within the country, and also within the wider world.

In the meantime, I spent my day sitting in a crowd at the John Garang Mausoleum, listening to a small delegation give speeches on HIV in South Sudan.

Thirty years on and the global community has made incredibly strides in the fight against HIV. But it hurt me to sit there today listening to the president speak, knowing that just when South Sudan needs that push the most, those opportunities are being swiped away from them.

Know your status y’all. Go get tested today.

To people living with, living with, living with – not dying from – disease.

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