While summing up progress, document notes rising rates among people who inject drugs, concentrated epidemics among other marginalized populations, poor rates of viral suppression, “appallingly low” treatment access for children, but suggests caps on international spending, limits on treatment
While the United Nations website posting the most recent global HIV report from the body’s Secretary-General calls it “HIS MOST CANDID REPORT EVER,” the document released in advance of a June international meeting at which nations will set new commitments to fight the pandemic, begins as such documents usually do.
It refers to ending the pandemic on “the fast track.” It lavishes praise on the world for “delivering more than results,” and expresses pride in what the world can accomplish when it works toward a common goal. Noting the price of failing to sustain progress, it even declares that accepting the current level of progress against the pandemic would mean that all the preceding efforts, “will have been in vain.”
The report, like others before it, matter-of-factly draws attention to those left out. While United Nations member states in 2011 agreed to halve HIV transmission among people who inject drugs, the report notes that HIV incidence is steeply on the rise in eastern Europe and Central Asia where injecting drug use drives transmission of the virus. It notes that in the Middle East and North Africa, where people who earn income through sex work, men who have sex with men and people who inject drugs bear the brunt of new infections are seeing incidence rise as well. And while applauding the some-months-early accomplishment of 15 million people receiving antiretroviral treatment, it notes that 22 million people still are not receiving treatment, and that rates of treatment access among children — as low as 15 percent of those who need it receiving it in some places, remains “appallingly low.” And the proportion of people for whom treatment is effective and consistent enough to suppress their viruses are similarly dismal in the United States and sub-Saharan Africa — about 30 percent.
Like other reports, the numbers it calls for go in understandable directions; treatment rates should go up, and infection rates should go down. These are presented as reasonable aims, with the Secretary-General arguing that contrary to “a perception that global solidarity has reached its limits . . . many countries have the ability to invest much more than they currently do.”
Then something unusual happens.
Projecting that total resources in low-and middle-income countries need to increase from 2014 levels of $19.2 billion to $26.2 billion, a chart halfway through the document does the math (“using country-specific inputs or estimates for each country”) and concludes that international (donor) resources to upper-middle-income countries should be cut by $1 billion. This is based on calculations that those countries, some of which the report has already noted are failing to meet the needs of their most vulnerable populations now, will add $2.5 billion to their 2014 spending. In all, the chart tabulates, international spending needs only rise by a little less than a third, while low- and low-middle income countries will be expected to increase their spending by 450 and 530 percent, respectively.
“We know governments [including the U.S.] don’t sufficiently fund programs for marginalized groups or NGOs that challenge social norms. We know international solidarity is key for key populations. But the UN system is advocating we give up the fight in [upper middle income countries]?” Matthew Kavanagh of Health Global Access Project wrote after reading the report. “This is the plan to ‘end AIDS’?”
The overall goal to add about $6 billion to funding levels by 2020, he noted in a piece he wrote on Health GAP’s blog last month, is “about what Americans will spend on Independence Day celebrations this year or what US Presidential candidates will spend on ads this election cycle. This is an entirely achievable goal.”
Adding to the mystery of a call for a spending cut, are contradictions between the report’s recommendations and the goals, with the report’s call for apparent rationing of treatment, saying “one quarter of global HIV investments should be allocated to prevention other than antiretroviral therapy . . .”
While the report ends with the Secretary General’s call to member states “and all stakeholders to urgently implement,” the report’s recommendations, Kavanagh cites the draft of the political declaration circulated last month that Member States will consider at the June High-Level UN meeting on the pandemic, and hopes they will do better.
“Luckily so far the draft HLM Political Declaration has avoided including this level of incoherence and calls on all actors to come,” he wrote, “but this sort of thinking shows a complete abdication of leadership from the United Nations Family.”