by Rev. Msgr. Robert J. Vitillo
Head of Caritas Internationalis Delegation in Geneva
As a veritable “dinosaur” in following the global response to the HIV pandemic, I recall only too vividly my fist visit to Uganda in the late 1980s, where I observed hospital wards crowded with HIV patients and heard constant cries of grief uttered by relatives who recently had lost their loved ones to AIDS-related illnesses. I also recall the angry insistence of participants from developing countries in attendance at the first International AIDS Conference to be held on African soil, in Cape Town, South Africa, during the year 2000; they insisted that access to life-saving and life- enhancing anti-retroviral medications could no longer be the “elitist” of HIV-positive persons coming from high-income countries. They demanded, in fact, that the global community had a responsibility to supply these medicines to all who needed them. I can never forget the honour and heavy responsibility that I felt when I was called upon, in 2006, by then-Executive Director of UNAIDS, Dr. Peter Piot, to join a small group of “experts” to design a framework for fulfilling that demand uttered at Cape Town – to provide Universal Access to all who needed and wanted it – not only to antiretroviral medications, but also to HIV prevention, support, and care.
I remember, too, the exhilaration, that I felt during a return trip to Uganda when I noticed that the sale of coffins was no longer the “growth industry” there – as a result of the “Lazarus effect” brought about to much more widespread availability of HIV medicines, even for poor HIV-positive persons, who once again were able to work and support their families.
After reading about such positive developments, you may be asking yourself about the reason for the rather pessimistic title for this article. The fact is that, despite progress made in supplying these medicines to some 4 million people living with a diagnosis of AIDS in developing countries, many more need such access (according to UNAIDS, at least 10 million people are in need of the medicines and according to the new treatment guidelines released by the World Health Organization (WHO) in November 2009, that number may be expanded to 14 million.
An even more pressing concern is that donor governments and other major funders seem to be reaching a level of “compassion fatigue” related to AIDS funding. Presently, some USD 10 billion is made available for AIDS funding each year; however, the experts estimate that some USD 27 billion is needed to make a dent in dealing with the gap in available HIV-related treatment, prevention education programming, care, and support. Instead of reassurances to provide more AIDS funding, however, a number of donors are indicating that there may be cutbacks in available funds. The USA has re-named its AIDS Relief programme as the “Global Health Initiative” and has indicated that the AIDS funding level will be increased only by two percent. In a somewhat similar move, the new government in the United Kingdom has indicated its plans to maintain health-related funding but has designated malaria and reduction of maternal mortality as two of its priorities.
Why, you may ask, is it so important to continue AIDS funding at the same or greater levels? The fact is that for every two persons who initiate HIV treatment at present, another five become newly infected. Public health experts do not anticipate a quick reversal of this trend; they predict that, in 2031,when the world will observe the fiftieth “anniversary” of the identification of AIDS as a new global pandemic, some 2 million people will still become newly infected each year.
As if concerns about funding for new infections in the future were not enough of a challenge, there are even more pressing concerns about present-day coverage for these medicines. During a recent visit to Uganda and during a meeting of the Catholic HIV/AIDS Network for Asia/Pacific a few weeks ago, those engaged in Church-related HIV programming shared with me their frustration that donors have instructed them to block any new admissions to treatment rolls and that, in some cases, they have had to inform current recipients that they no longer were eligible for such care. All this, despite the fact that only two or three years ago, donors assured faith-based organisations that they were making long-term commitments to AIDS funding. On the basis of such encouragement, many Caritas and other organisations of Catholic inspiration scaled up their treatment programmes to the point that the AIDS Office of the Southern African Catholic Bishops’ Conference and the Health Commission of the Catholic Bishops’ Conference of India are major stakeholders in the treatment coverage of their respective national programmes just to give two examples. Other countries where the Catholic Church is a major stakeholder in this field include Ghana, Rwanda, Ethiopia, Zambia, and Papua New Guinea.
These funding cutbacks augur not only a return to the days of crowded hospital wards and cemeteries jammed with relatives burying their dead. They also raise grave concerns about the risk of developing additional resistant strains of HIV that could be spread by infected people who cannot be maintained on a constant supply of these medications.
In 2009, Caritas Internationalis launched its “HAART for Children Campaign” to advocate for early testing and treatment for children living with HIV or HIV/TB co-infection. We did so at a time when the treatment coverage for HIV-positive adults seemed to be steadily improving. Given the recent trends mentioned earlier in this article, however, perhaps it is time for us to confront the haunting question of whether “Universal Access” was only a fantasy and thus re-double our advocacy efforts to assure HIV treatment, care and support to all – adults and children alike – who need it – most especially to the poor and marginalized people of the world – those to whom Caritas has received a special mandate and calling.