Reversing the AIDS epidemic: What has worked, what has not?

As the discussions continue further at XIX International AIDS Conference (AIDS 2012), the consensus is that a lot of progress on fighting with HIV has been made. From death sentence in early 1980s, AIDS is now a chronic and manageable disease. A global 20% reduction in prevalence rates since 2000 is a significant achievement. Stories from countries like India bring hope. The Government of India presented the achievements of its National AIDS Control Programme (NACP) at AIDS 2012. India has recorded a 56% reduction in the prevalence rate in last decade. In a country that has remained impacted with poverty, other serious health problems, and funds deficit, this achievement is overwhelmingly positive. This has brought India’s HIV prevalence rate to 0.31%.

Government of India representatives give the credit to four important factors. One, is the increasing financial contributions to NACP from within the country currently standing at some 76% of overall money spent on HIV. Two - the convergence of a range of health programmes in a diverse country. Three  - the policy level reforms with greater focuses on decriminalization and availability of treatment, and four – a strong political will with a continued commitment.

As the increase of prevalence rates is noted in North Africa and East Europe, India is story is inspiring and shows the path. “We are looking at a new world with new resources though, which changes the picture” – comments Bernhard Schwartlander from UNAIDS.  A number of countries in recent years have moved from a low-income status to middle income status with Brazil, Russia, India, China and South Africa leading the way. It is also the middle-income countries where HIV infection is concentrating more and likely to do so in future.

Almost in all parts of the world, the domestic funding has been on increase providing strength to national AIDS control programmes. 81 countries have seen an increase of up to 56% on their domestic spending on AIDS. This is a positive sign, but in no way means that the International Assistance has a lesser role to play, especially on the research and treatment sides.  An adequate balance between dependence, self-reliance and sustainability must be ensured.

The progress is uneven too, as UNAIDS explain. For example, Brazil and Russia are about the same in the context of population, GDP and money spent on the fight with AIDS, But, there is a significant difference between the two countries on the state of the epidemic – Brazil faring much better than Russia. This would then be definitely linked to the policy reform processes and the role of civil society. Crucial factors in epidemic control, as has been proved.

In Barcelona International AIDS Conference in 2002, an ambitious target of providing ARTs to 3 million people living with HIV by 2005 (WHO's 3 by 5 initiative) had been set.  The progress did get late by years, but finally has went beyond the target. Over 8 million currently live on ARTs. But the progress has to be equally spread with more ART coverage and a special focus on the drug users contingent where the epidemic is hitting the hardest. In conclusion, there is more good news than bad news on reversing the epidemic. However, exchanges will enhance the efficacy further towards an AIDS free generation.

Prakash Tyagi - CNS
(The author leads GRAVIS and writes extensively on HIV related issues)

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