At a historic UNGASS (UN General Assembly special session) in 2001, Kofi Annan declared war on AIDS. He did not intend this war to become permanent, for the “fight against AIDS” to become a fixture of global politics. Deadlines were set: universal access to treatment by 2010, a reversal of the epidemic by 2015. In early June, five years after UNGASS and twenty-five years after the first reported cases of the disease, world leaders reconvened to assess the state of this war, and despite significant progress in funding and treatment, many concluded that the UN’s benchmark goals are quickly moving out of reach. “The epidemic that has inflicted the single greatest reversal in the history of human development…continues to outpace us,” warned Annan at the close of UNGASS+5.
Yet there is some reason for optimism. Five years ago there was little internationally coordinated funding for AIDS, no alphabet soup of agencies dedicated to fighting it–no US PEPFAR (President’s Emergency Plan for AIDS Relief), no WHO 3×5 (the World Health Organization’s plan to treat 3 million people by 2005), no Global Fund. Big Pharma fiercely resisted price discounting and generic production of antiretrovirals; trade officials in wealthy nations agreed and also helped to stymie much-needed debt relief. In short, whole swaths of the developing world were left for dead.
This is no longer the case. Last year the world spent $8.3 billion on HIV/AIDS, up from a paltry $1.2 billion in 2000. The G-8 members have pledged $38 billion in debt relief to seventeen poor nations. These steps have produced results on the ground: WHO has put 1.3 million new people on life-saving medications at prices once thought impossible, and after the IMF canceled $5 billion of Zambia’s debt, President Levy Mwanawasa announced free basic healthcare for all citizens.
Beyond measurable accomplishments such as these, increased funding and attention have fueled and emboldened the global people’s movement against AIDS. A growing corps of civil society organizations now monitor, heckle and cajole governments and international AIDS organizations. Inside the halls of the UN they, along with the Rio Group of countries led by Brazil, led the call for firm treatment targets and the specific mention of “vulnerable populations” (men who have sex with men, sex workers and IV drug users) in the final declaration–though their proposals were ultimately blocked by delegations including the United States, the Organization of the Islamic Council and South Africa.
Still, these activists and NGOs face a daunting task. Though UNAIDS estimates that $23 billion (almost triple current funding levels) will be needed annually by 2010, UNGASS+5 set no firm targets for funding or treatment. The Global Fund, which subsidizes almost half of all AIDS treatment to people in the developing world, recently announced its sixth round of grants but lacks the money to fund them. The WHO and UNAIDS have yet to launch a successor to 3×5, which failed to reach its ambitious goal. Moreover, according to WHO’s own evaluation, those who received treatment did so through existing hospitals and clinics that are now “saturated.” Without a massive and immediate increase in funding–not just to purchase more medicine but to build the healthcare infrastructure necessary to reach more marginal populations–the promise of universal access will become “a cruel joke for people living with HIV and AIDS,” according to the International Treatment Preparedness Coalition.
Bush’s AIDS plan is a particularly thorny gift. Widely touted as having quadrupled US AIDS funding from Clinton Administration levels, it nonetheless circumvents the multilateral Global Fund, an imperfect but more transparent and accountable body. Moreover, according to a recent GAO audit PEPFAR’s emphasis on abstinence hampers the ability of grantees to “respond to local prevention needs,” and nine countries have decreased funding for mother-to-child transmission programs to meet abstinence promotion requirements. So onerous are these and other US dictates against prostitution and abortion that many African activists at UNGASS+5 expressed envy at the ability of Brazil–a relatively wealthy nation–to decline US AIDS funding altogether.
At the moment, such independence is impossible for AIDS groups from poor nations who depend on the vital treatment dollars attached to PEPFAR. “A work of mercy” is how Bush introduced his AIDS plan in 2003. But the UNGASS review made clear that what people with AIDS need now–besides more money, more doctors, more nurses and more drugs–is not mercy but power. It was, after all, the militancy of groups like ACT UP and South Africa’s Treatment Action Campaign, which exposed the injustice of government neglect of people with AIDS, that placed treatment on the agenda to begin with–not UNGASS or the noblesse oblige of the powerful who signed the declaration that emerged from it. And if the world is to meet the goal of universal access by 2010, it will be because of the continued militancy of activists who hold world leaders accountable for ending, and winning, the war on AIDS.