The December 2011 episode of Development Matters, the podcast of the London International Development Centre, coincides with World AIDS Day.
According to UNAIDS estimates, there are now 33.3 million people living with HIV, including 2.5 million children. During 2009 some 2.6 million people became infected with the virus and an estimated 1.8 million people died from AIDS.
On 1 December the international community celebrates the World AIDS Day. In 2011, the theme is 'Getting to Zero': "Zero new HIV infections. Zero discrimination. Zero AIDS-related deaths".
Anna Marry of LIDC talked to two Bloomsbury Colleges experts on the subject:
Deborah Johnston, Senior Lecturer in Development Economics at the School of Oriental and African Studies; and Peter Godfrey-Faussett, Professor of International Health at the London School of Hygiene and Tropical Medicine, and consultant physician at the Hospital for Tropical Diseases.
Peter Godfrey-Faussett said that in late 2011, while new infections are still rising fast, we have effective ways of preventing them (such as through male circumcision, making condoms widely available etc.), and we have effective treatment with anti-retrovirals.
Deborah Johnston emphasised the economic cost of the disease – negative effect on economic growth, lost productivity, but also an impact on poverty that is rarely captured in studies. In South Africa, households affected by HIV/ AIDS only achieve 60% of the income of those unaffected. In terms of tackling the epidemic, cash transfers are increasingly popular and some of the programmes involving them do indeed reduce HIV prevalence, but, aside from ethical concerns, there are also doubts as to their sustainability once the financial incentive has been removed. To make such programmes work, one needs to understand the structural drivers of AIDS, such as income, inequality, gender and violence. Cash transfers can work if used to change those structural factors (e.g. raise the social status of women or change sexual norms).
Both speakers talked in length about changes in the funding landscape for HIV/ AIDS, with the Global Fund cancelling its next round of funding, and Britain cutting its aid allocation. Deborah Johnston pointed out that the global financial crisis has had implications not only for HIV/ AIDS, but for whole health systems, and not only in aid recipient countries. Peter Godfrey-Faussett recalled the enormous gains achieved over the last years and expressed fear that we may now lose the momentum, scaling down interventions that research shows we should be scaling up.
So what do we know about HIV/ AIDS in 2011 that we did not know a year earlier? Peter Godfrey-Faussett talked about recent successes in anti-retroviral treatment for discordant couples (one HIV positive and one negative), and Deborah Johnston explained that we now have a better understanding of the links between migration and HIV/ AIDS.
The speakers agreed that thinking about HIV/ AIDS across disciplines, bringing public health perspectives together with those offered by social science, is enormously beneficial and deepens our understanding of the disease, as well as refines policy responses. The expressed hope that in 2012 the Global Fund reform will have been completed, with donors regaining confidence and increasing funding, and we will have gained a better understanding of structural drivers of AIDS.
Listen to the podcast
Read the LIDC blog post ‘A message for World AIDS Day 2011: get your health system sorted out!’ by dr. Dina Balabanova of LSHTM