According to UNAIDS, this World AIDS Day will be the first time that we can celebrate the possibility of the eradication of HIV, and therefore AIDS, in the foreseeable future.
In the words of Michel Sidibé, executive director of UNAIDS: “The pace of progress is quickening – what used to take a decade is now being achieved in 24 months.
"We are scaling-up faster and smarter than ever before. It is proof that with political will and follow through we can reach our shared goals by 2015.”
UNAIDS believes that “the evidence gathered from countries around the world tells a story of clear success” and that “a new era of hope has emerged in countries and communities across the world that had previously been devastated by AIDS.”
Unfortunately it is highly questionable whether such a rosy view can really be taken of the HIV/AIDS epidemic.
There is no doubting that in the last decade there has been significant progress.
Because of struggles led by activists around the world by the end of 2011, eight million people in low- and middle-income countries were receiving antiretroviral treatment. That amounts to a 20-fold increase since 2005.
There has also been progress in the technology of HIV prevention.
There now exists an armoury of interventions for combination HIV prevention: male and female condoms, medical male circumcision, post and pre- exposure ARV prophylaxis, and not too far away, microbicides.
We also know now of the preventative benefit of anti-retroviral treatment which dramatically reduces the infectivity of a person with HIV.
Discrimination
Unfortunately, however, human behaviour remains stubborn and complex and the take up of HIV prevention cannot be demonstrated with the same confidence that we have seen the take up of ARV treatment.
This is often because of the stigma and discrimination that is tied to HIV.
Many women are afraid to tell their male partners for fear of violence and rejection. Many workers still face dismissal for being HIV positive.
Earlier this year, for example, ITUC took up the case of MR, a journalist expelled from Qatar and sacked by Al Jazeera because of his HIV status. MR is still unemployed.
If we are honest, we will recognise that the end of AIDS will only come with the end of discrimination and the advent of equality.
Furthermore, it is an unfortunate fact that up to now most governments, as well as UNAIDS, have not paid enough attention to the quality of HIV prevention and treatment programmes.
The response to the AIDS crisis in many countries – including those pivotal to the future of the AIDS epidemic, such as South Africa and China – has seen a dearth of qualitative information/evidence about patient retention, drug adherence, adverse effects, discrimination and human rights violations.
Another factor that needs to be considered, especially in South Africa, is the effect of collapsing public health systems on treatment programmes.
By ignoring the quality of services dynamite has been built into the edifice of the AIDS response – and the clock is ticking.
In South Africa, for example, which is still home to almost a quarter of the world’s HIV infections – 5.1 million people according to UNAIDS – there is still a high rate of new HIV infections, particularly amongst young women and girls.
Similarly, although there are 1.7 million people receiving ARV treatment, there is still a high rate of maternal mortality and the lives of two million more people depend on getting access to ARVs in the next three years.
South Africa is said to have a ‘generalised, predominantly heterosexual’ epidemic.
But it is also a country that in some ways represents the world of the AIDS epidemic: it hosts most of the globe’s sub-epidemics.
For example, separate epidemics exist among men who have sex with men (MSM), sex workers, drug users, undocumented migrants and other marginalised people. Each of these epidemics has its own story to tell about whether we are succeeding, or not, in controlling HIV.
These are facts that are making it more and more clear that ‘the end of AIDS’ will depend on the end of injustice.
Setbacks
From the earliest days of the AIDS epidemic the pace of development of medicines, human rights protection and political will was driven by civil society, and particularly by vociferous and activist organisations of people living with HIV, such as ACT-UP, the Gay Men’s Health Crisis and later the Treatment Action Campaign in South Africa.
Over the last ten years, the massive rise in expenditure on HIV was generated by activism.
It also resulted in much greater expenditure on health systems. But in the context of economic recession and stagnation many developed countries are turning their backs on poor people with HIV.
Class is once more becoming a determinant of access to treatment.
Developed countries are also turning off the taps that provided funding to NGOs, CBOs and social movements.
Despite civil society being considered a ‘critical enabler’ in the UNAIDS Investment Strategy, there seems to be no strategy to sustain civil society or to advocate for its funding.
In this context it has to be debated whether organisations like the UNDP and UNAIDS, which spend millions of dollars on HIV-related ‘commissions’, per diems and travel would not have been better advised to make a similar amount of money available to organisations that truly have the capacity to alter the epidemic curve.
Finally, let me say that in the first three decades of the AIDS epidemic the mighty global trade union movement could have done much more to mobilise its tens of millions of members around HIV.
Our appeal is that this must now change. Tackling HIV is not just about fighting a virus.
The social determinants of HIV are gender and income inequality, social marginalisation, unfair discrimination, low wages, job insecurity and unaccountable government. They are in injustice.
On World AIDS Day 2012 we should recognise that AIDS activists and trade union activists have a lot in common. It is time we joined our battles!
