Wrong on HIV/AIDS

The United Nations held a high level meeting on AIDS last week. Representatives of over 140 governments met to review progress towards goals laid out in 2001 and to draft a statement laying out priorities for the next five years. The big controversies of the week show that the UN, and our own government, are focusing on the wrong issues.\nThe two hot debates at the UN meeting were over setting precise funding targets and avoiding direct reference to the fact that sexual behavior is one of the main means of transmission of HIV. Many NGOs and countries want the declaration to say that UNAIDS, the United Nations AIDS program, needs $20 to $23 billion through 2010. The United States, already the largest donor to UNAIDS, prefers targets on the number of people treated and the number of infections prevented, rather than how much money is spent. In this the United States is right. It's not about how much we spend, but how much we do.\nUnfortunately the United States isn't on the right side of the other big controversy -- trying to avoid mentioning sexuality and lifestyle related choices, along with weakening references to gender and sex. The drive to sanitize the declaration was led by the Organization of the Islamic Conference, a coalition of conservative Islamic countries -- but the Bush administration, also opposed to condom distribution and gay rights, was undoubtedly happy to hide under their wings.\nEqually disturbing is the conference's overwhelming focus on the treatment of people who are already infected instead of preventing future transmission. It's easy to understand why. The infected are a concrete group who have a face, and no one wants to be seen to be abandoning them. When you add in the fact that the same countries that don't want to mention sexuality also don't want to talk about serious methods of prevention, such as distribution of condoms, prevention comes out on the short end. \nBut it shouldn't. UNAIDS says that there are more new infections than deaths each year and that the "vast majority" of those who are HIV positive don't know it. The current strategy of focusing on treatment of the sick means that the number of infected will continue to rise. There are already more sick people than we can treat. If there are even more sick in the future, it will mean even more people we can't treat. But we can dramatically decrease infection rates.\nUNAIDS estimates that increasing prevention programs in 125 low and middle-income countries could prevent 28 million infections between 2005 and 2015, saving $24 billion in treatment costs. By comparison only 1.3 million people in those countries receive anti-retroviral treatment. Doubling spending would still reach less than 3 million people, compared to the 28 million infections we could prevent by focusing on prevention. I'm not saying we should stop working to distribute low-cost ARV medicines, but we can do a lot more by getting serious about realistic prevention programs. Helping two or three million people is good. Saving 28 million lives is better.