Treatment is Just the First Task with AIDS
Published in the Financial Times (registration required): August 5, 2008
By Luis A. Ubiñas
When Awino lost her husband to AIDS in 2002, she also lost her family’s only source of income. Left alone and HIV-positive, her life was saved by a programme in Uganda that provides access to antiretroviral drugs. Yet today, with the virus barely detectable in her blood, AIDS is still ravaging her life. Having robbed her family of its livelihood, the disease is pushing Awino and her four children to the depths of extreme poverty.
More than 33m people globally live with HIV. In response, governments, non-governmental organisations, health professionals and others are rushing to meet a critical goal by 2010: ensuring universal access to HIV prevention, treatment, care and support.
At this week’s International AIDS Conference in Mexico City, the most prominent question among many participants – and the media – is whether we can meet that goal. But another, just as critical question is too often ignored: what happens once we do?
While the world still faces urgent challenges in the effort to achieve universal access, antiretroviral drugs are changing the face of AIDS. In low- and middle-income countries, close to 3m people were receiving antiretroviral therapy by the end of 2007, according to the World Health Organisation. In the US, someone diagnosed with the AIDS virus who receives treatment can expect to live about 24 years on average, says a study published in the journal Medical Care.
It is not too early to ask ourselves: what will it take to create a world where people can live full lives with AIDS?
The answer lies not only in sustaining access to treatments, but also in breaking down the social, political and economic barriers that often prevent sufferers from living full and productive lives. To do this, governments, NGOs, and others must take a more comprehensive approach.
Far too often, the world’s governments are failing to protect the rights of people living with HIV to live a life of dignity, earn a livelihood, gain access to healthcare, be free of stigma and violence, and even to travel. One-third of countries lack laws to protect sufferers from discrimination, according to the United Nations. And while 74 per cent of countries have policies to ensure that vulnerable groups have equal access to HIV-related services, 57 per cent of these have laws or policies that impede access to those services. As we struggle to transform HIV/AIDS from a death sentence to a manageable condition, we must begin to understand the critical human rights issues that result.
Awino’s struggle, chronicled last year in the Health Policy and Planning journal, demonstrates that economic security, health and human rights are closely intertwined. The AIDS movement must include innovative efforts to address the social, cultural and political factors that shape the impact of this disease.
A few basic principles can guide this more comprehensive approach. First, people from diverse economic and social backgrounds – including women, marginalised communities and people living with HIV – must be incorporated into the highest levels of the global response to AIDS. These new leaders can develop solutions relevant to their communities. In Latin America, for example, HIV-positive women have formed ICW Latina, a network of female leaders addressing the lack of information and services available to women living with the disease. With support from the Ford Foundation and others, ICW Latina has recruited hundreds of women and established education and advocacy centres in 17 countries.
Second, governments must be held accountable not only for advancing best practice in prevention and treatment, but also for removing discriminatory barriers to those services and enacting and enforcing laws that allow sufferers to lead lives with dignity.
Finally, all of us must make equity a core value. This means ensuring that the most effective programmes are equally accessible across gender, geography and socio-economic status. Equity helps us move simultaneously toward universal access and the longer-term goal of ensuring that people can live full and vibrant lives with the disease.
Awino is one among millions of women, men and children who show us that the fight against AIDS is about more than medicine. They challenge us to ensure that progress toward universal access is matched by a commitment to confront the social and cultural factors facing people living with the disease. As thousands gather for the International AIDS Conference, it is a goal we should all agree to work together to meet.
The writer is president of the Ford Foundation.
Read the article in the Financial Times (registration required).
Learn more about the Ford Foundation's Global Initiative on HIV/AIDS.