Outside editorial: Hope against an AIDS pandemic

Posted: Sunday, December 02, 2007

The following editorial first appeared in the Washington Post:

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The global HIV-AIDS pandemic has required an unprecedented response. Governments, private organizations and millions of individuals have had to tackle a chronic disease that is incurable but that can be treated through a relatively complex set of medical interventions. Unlike in the mobilizations against polio, smallpox and other killers, there is no one-shot vaccine for HIV-AIDS, so an entire life-saving system has had to be constructed from scratch. And it is being built in some of the world's poorest countries, places where there is not only no money for medicines but also hardly any doctors and pharmacies to prescribe or distribute them.

In such an effort, there are inevitable setbacks and mistakes - even a few embarrassments, such as the United Nations' acknowledgment that it overstated the extent of infections, despite warnings in recent years that its estimates were high. The United Nations now says there are about 33 million cases worldwide, rather than over 39 million, as it had suggested. New infections in 2007 were 2.5 million, down from 3 million a year in the late 1990s. Estimates of those living with HIV in India have been revised downward by about half, suggesting that fears of an explosive spread of the disease from its African epicenter are not coming true.

This is not good news about the U.N.'s past information-gathering and dissemination, and UNAIDS, the organization's lead agency on the disease, needs to learn and apply the appropriate lessons. Its credibility is a vital asset in the war against HIV-AIDS. Nor is it encouraging to learn, as The Washington Post's David Brown reports, that the number of Americans who become infected with the virus each year is higher than thought. But, on this World AIDS Day, the scaled-back U.N. estimate of HIV-AIDS's global prevalence is cause for a measure of celebration - and for rededication. The revised U.N. numbers are a success story for a U.S. government program that supports disease surveys in heavily affected countries, demonstrating the benefits of investments in strategic health information. More broadly, of course, it is wonderful news that fewer people worldwide are in danger of dying from a horrible illness and that the task of bringing the pandemic under control is not quite as daunting as it once seemed.

All the more reason to sustain a robust international response. Even with the correction in its statistics, UNAIDS believes that it would cost $40 billion to meet the Group of Eight's goal of near-universal access to treatment by 2010. The United States must continue to lead. Over the past five years, the United States has spent about $15 billion under the President's Emergency Plan for AIDS Relief. Thanks in part to that commitment, nearly 1.4 million people in Africa are receiving the medicines they need - 28 times as many as in 2004.

Still, as the disease matures, more dollars need to go into strengthening health-care delivery systems in the developing world. The president's proposal for 2009-13 would authorize an additional five-year contribution of $30 billion, double what was spent during the past five years - but less than the United States would provide if it were to increase annual spending as rapidly as it did in the past half-decade. Money for HIV-AIDS must, of course, take its place among many needs in the American foreign aid budget. But this is no time for complacency or "donor fatigue." HIV-AIDS is still a medical Mount Everest; perhaps, though, the peak is at last in sight.

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