The central theme of the International AIDS Conference was supposed to be the war on drugs. As I highlighted in my last post, criminalization has been proven to fuel the epidemic, while engaging directly with people with a higher risk for HIV significantly decreases transmission and death. The conference was in Vienna expressly to “bridge” west and east Europe (no eastern European country could logistically handle hosting) and to bring attention to drug use.
Outside of Sub-Saharan Africa, thirty percent of new infections occur among people who use drugs. In Russia HIV prevalence jumped fro 0.5 percent in 2001 to 1.1 percent in 2008. All of these are good reasons to highlight drug use, and it could have been exciting if anyone had picked up on the issue. But the New York Times reported that the White House didn’t even read the Vienna Declaration (the document calling for an end to the drug war). And throughout the conference, focus shifted to the new microbicide trial and mostly demands for more funds.
The inequality in access to ARVs is stark. While the US is itself struggling to maintain public access, only 30 percent of ART needs in the developing world is currently met. Currently 5.2 million people have access, but new World Health Organization guidelines suggest that people go on treatment earlier, when the CD4 count is 350 cells/mm3, instead of the previously suggested 200 cells/mm3. The CD4 count is a way of measuring immune system strength. As CD4 count decreases, the immune system is weaker, and new studies show that having the count drop can damage the immune system, even when people go on treatment and raise their CD4 count.
The global estimated budget for low and middle-income countries for HIV is $23.6 billion. The G8 has increased funding every year, from $1.2 billion disbursed in 2002 to $7.7 billion last year. This year commitments flatlined and disbursements dropped to $7.6 billion. This angered advocates and activists, who suggested a “Robin Hood tax” on international financial transactions, which would add a miniscule charge that would add billions to the AIDS budgets.
These numbers are a bit shocking. HIV is a huge issue (an estimated 33.4 million people were living with HIV in 2008), and universal access is a noble goal. I struggled at the conference, though, to understand the cries from the international AIDS elite in the crammed halls of the Reed Messe Wien conference center.
The official conference budget was $23.5 million, which did not include the travel and housing expenses of the 19,300 participants. While picking up hundreds of printed reports and documents, specially decorated condoms and tee-shirts, free coffee, wine and food, and enjoying the colorful condom mosaics bedecking the walls, I felt the cries for more money were somewhat distasteful.
The conference is useful because it shines a light on the epidemic—media coverage of HIV spikes around the conference. It also serves as inspiration and motivation for those engaged in the exhausting daily work of facing HIV on the ground. But Elizabeth Pisani, an epidemiologist and commentator who spoke with me and a group of journalists ahead of the conference talked about the “AIDS mafia”–high level institutions and diplomats who live well while touting the cause of HIV in the poorest countries.
Perhaps Pisani’s language is a bit harsh, and Michel Sidibé, executive director of UNAIDS did call for streamlining of the budget. But as with all humanitarian issues, it is important to follow through and question where money is going. If citizens want to donate to fight AIDS, I would suggest double-checking if the money goes to funding prevention and treatment, or if it goes toward funding cocktail hours such as those hosted by numerous foundations and NGOs during the conference.
