AIDS: Act now or pay later

Peter Piot and James Wolfensohn, World Bank

When HIV/AIDS kills someone new every 15 seconds, it is painfully clear this disease is not just another health issue. AIDS goes to the very heart of economic and human development, and demands that the entire world mobilizes to throw back the spread of AIDS, and treat the sick and care for the dying, with fairness and dignity.

The latest figures from UNAIDS show AIDS is no longer an issue that can be labeled mainly an African problem. AIDS is continuing its relentless march across countries and continents, truly becoming a globalized disease, with the fastest-growing epidemic spreading in Eastern Europe and Central Asia. And China, India and Indonesia are not far behind, threatening an AIDS explosion that could far outstrip current numbers.

As the disease spans the globe, it is also affects women more and more, a trend that is not well-known. In Africa, women now make up 60 percent of people living with HIV, causing serious problems for social and economic development. Given that women are the main caregivers and the source of household labor, their illness means the collapse of family care and household income.

We are already beginning to see how these profound demographic shifts are ripping the very fabric of societies. Consider the plight of the millions of orphans left behind when AIDS strikes down their parents and other relatives. There are now 14 million orphans affected by AIDS in Africa, adding to the growing number of street children and child-headed households.

And most worrisome is the impact AIDS will have on the capacity of the state and the private sector to deliver services. AIDS robs countries of service providers, which in turn contributes to failings in development, prompting a vicious circle.

Despite these worrying trends, there are clear signs that the global response to AIDS is entering this a new phase of opportunity, driven by political will, evidence of what works, and increased resources to fight the epidemic.

Firstly, there has been a sea-change in the political momentum to respond to AIDS. Today, when global leaders meet, AIDS is on their agenda, as was the case during the recent meeting in London between Prime Minister Tony Blair and President George Bush. By investing much political and economic capital in the global fight against AIDS, Americas role here is especially important.

Yet too many governments, and international institutions still not take AIDS as seriously as they should.

Second, evidence is mounting that we can bring the epidemic under control. We are seeing more and more instances of prevention success on all continents. And with the fall in prices of anti-retroviral medicines, the scaling up of effective HIV treatment is now a real possibility, driving a number of national and international initiatives forward. Take the Three- by-Five Campaign that the World Health Organization launched in September together with UNAIDS to provide 3 million people with anti-retroviral treatment by 2005.

Third, donors and developing countries are devoting more resources to fighting AIDS, such as the Global Fund to Fight AIDS, TB and Malaria. In addition, the World Bank's innovative Multi-country AIDS Programs have pioneered new mechanisms to support local authorities and non-governmental groups on AIDS, particularly in Africa and the Caribbean. In the past five years, the World Bank has committed US $1.5 billion through grants, loans and credit programs to fight HIV/AIDS, most of this in the form of grants to sub-Saharan Africa.

It may surprise people, for example, to learn that there are more than 1,000 community groups in Kenya, and roughly 3,000 villages in Ethiopia receiving World Bank support through the program. This progress should serve as an incentive for other donors to use these kinds of mechanisms.

The world has learned a lot about fighting AIDS during the last 20 years. Some developing countries have shown real success in their response to AIDS, particularly when it comes to preventing new infections particularly among young people. We know the successes of Uganda, Senegal, Brazil, Cambodia, Thailand, but there are now an increasing number of major cities in East Africa, like Kigali and Addis Ababa, where we are seeing a decline in the number of new infections among young people as a result of prevention efforts.

But these few successes will need to be sustained, and replicated to make the fight truly effective.

As for any problem, leadership is key . No money can replace courageous leadership at all levels. This is not only at the top of the country, it is at every level. Success comes from sustained and comprehensive approaches on prevention, treatment, and mitigating the diseases impact.

A big part of that is breaking down the stigma and discrimination that all too often blights the lives of people living with AIDS, and prevent people from taking advantage of prevention and care services. On AIDS, it is abundantly clear that either we act now or we pay later. Africa has learned its lesson the hard way, and denial and ignorance cannot reverse this epidemic. But it is a lesson that the countries of Asia and Eastern Europe have got to take to heart now.

Most importantly, communities, families, and individuals need to rewrite the rules of how we deal with those sensitive issues at the heart of this epidemic--sex, adultery, homosexuality, rape, drug use, and how men and women relate to each other. Each community needs to find its own language for addressing these realities.

This is already happening in many places around the world with encouraging results. But what is now exceptional needs to become commonplace. Nothing spreads HIV faster than silence.

Peter Piot is Executive Director of UNAIDS and Under Secretary General of the United Nations; James Wolfensohn is President of the World Bank Group, a co-founder of UNAIDS.