Once touted as a shining example in the battle against HIV in Africa, Uganda was featured two days ago as the first–but not the last–example of “how the war on global AIDS is falling apart” in a New York Times series highlighting the shortfall in funding, the US’s (diminishing?) contributions, the failures of scientific efforts to develop vaccines and microbicides, and the behavioral/cultural factors that make it so difficult to control the spread of HIV.
Although Uganda had once managed to decrease its HIV incidence rates, it appears that new infections are on the rise again, caused in part by a recrudescence of unprotected sex due to enduring social patterns of transactional sex, poor education, and a general lack of female empowerment, among other issues. This is particularly problematic at a time when funding is drying up due not only to Wall Street’s shenanigans but also to donor fatigue. As the article reports, hope soared in the last decade as efforts by MSF, the Clinton Foundation and others led to dramatic falls in the prices of drugs, presenting a tremendous opportunity for international donors to make an impact by making available the life-extending drugs that hade been available for years in developed countries but remained out of reach for the vast majority of HIV patients.
This “golden window” is now closed; some of the funding initiatives and grants that helped to open clinics are coming to an end, and no new money is coming in to increase the availability of treatment, at least not at the pace needed to seriously curb the epidemic. The result? HIV patients in Uganda are now being turned away from clinics. There is justified fear that this “Kampala situation” will only spread to other countries and set us back to where we were in the 90s, when so many died without any hope for treatment. This is particularly alarming in the case of the HIV epidemic, with success being heavily dependent on not only maintaining already existing treatment slots but also increasing treatment availability rapidly. The situation is alarming, but I hope that the alarm bells will lead not to panic but rather to a serious examination of the mistakes that have been made and a reformulation of how we practice global health. Continue reading
