Saturday, December 1, 2007

World AIDS Day

The number of people who have been touched by this plague, and the number of friends and colleagues I know who have been infected and whom the world has lost is beyond count. The pace of the disease has been slowed in the last ten years, but one death one is one too many.

Josh Ruxin is a Columbia University expert on public health who has spent the last couple of years living in Rwanda. He’s an unusual mix of academic expert and mud-between-the-toes aid worker. He tells us what’s left to to.

A slew of reports will be released this Saturday; though little of the news will be good, there is some progress worth celebrating. After six years of activists begging for 10 billion dollars per year in funding, the Global Fund to Fight AIDS, Tuberculosis and Malaria and PEPFAR (the President’s Emergency Plan for AIDS Relief) might actually reach 40 percent of that goal in 2008. Across the world more and more people are being tested for HIV and put on treatment, the cost of which is at levels unimaginable just a few years ago.

So why aren’t we having a big celebration on this World AIDS Day? Because overall — and certainly in consideration of our abilities — we’re not doing nearly enough to address the disease.


Here are the facts: the data has changed because there are more programs reaching more villagers and more of the poor than ever before. And since AIDS is principally an urban phenomenon, as testing gets out in the countryside, fewer people are being identified as HIV positive.

Good news right? Yes, except that out of the 33 million, 27 million are in Africa, and only about one million are receiving treatment. That means that nearly 2 million Africans will die of AIDS this year and roughly that number will be infected. The seeds of our future public health battles are being sown before our eyes.


On this World AIDS Day, it may be time to finally recognize AIDS for what it is: another symptom of poverty. The startling statistic that 5 percent of adults in our nation’s capital (roughly the same prevalence rate as in Rwanda, where I live) are HIV positive drives the point home. The fight against AIDS cannot and should not be fought in a vacuum. Policy-makers must cease making zero-sum choices between fighting maternal mortality (which has had relatively flat budgets for the past decade) or child health (which also has flat budgets) or neglected tropical diseases (which have been grossly neglected) and start owning up to the fact that only comprehensive, holistic approaches will work.

That means investments not only in the spectrum of health challenges facing Africa, but investments in growth — from agricultural productivity to entrepreneurship. AIDS cannot simply be fought with a pill, a testing kit, a condom or a circumcision. Though all are good approaches, AIDS must be fought with serious investments in the lives of the poor.