Once upon a time, when AIDS was a certain and not-too-distant death sentence, headlines screeched about the loss of life and the efforts to end the scourge. You don’t read or hear much these days about that doom and gloom, or the ongoing work to fight the disease.
That’s largely because of good news: There has been great success on the HIV/AIDS battlefront. Where deaths were once so commonplace that a diagnosis had victims making funeral arrangements and getting their wills in order, the emergence of effective anti-retroviral drugs has made HIV infection a treatable chronic disease. And crucially, the establishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria in 2002 – with key support from the United States during President George W. Bush’s administration – has made the worldwide fight against AIDS (and the other daunting diseases) a winnable one.
In sub-Saharan Africa, where about two-thirds (25 million) of all people with HIV live, more than 3.2 million are now receiving treatment with anti-retroviral drugs. In 2002, that number was only 50,000. Millions of lives have been saved worldwide.
Now, with a Global Fund donor conference set to take place in Washington, D.C., next month, organizers are making an urgent plea for continued commitment. They say with a pledge of funding at current levels there is the potential to eliminate HIV/AIDS, TB and malaria in the next generation.
There is ample reason for such optimism. Through treatment, research (in which North Carolina is playing a prominent role) and data pinpointing the hotspots for risks, these diseases are being vigorously and effectively battered. With Global Fund support, the costs of drugs to treat HIV/AIDS has dropped dramatically over the last decade from $10,000 per year to less than $200. As a result, 5.3 million people worldwide are receiving the life-saving anti-retroviral drugs and the incidence of AIDS has dropped by more than 50 percent.
The Global Fund’s impact on TB and malaria is also noteworthy. The fund has increased the percent of households in Africa with anti-malaria bed nets from just 3 percent in 2000 to 53 percent today, leading to 50 percent fewer malaria cases and 33 percent fewer deaths in the past decade. The fund also has helped detect and treat 11 million cases of TB, and is credited with a more than 40 percent drop in TB deaths in recent years.
People like Zambia’s Luwiza Makukula are alive because of those efforts, and give heart-rending testimony on the Global Fund’s behalf.
“I was on death row,” Makukula, who is living with AIDS, told me on a visit to Charlotte Tuesday. “I was sick. I was in a wheelchair. I was hospitalized. I had loss of memory. I could not do anything. It was that bad. You know, it was a situation where my family did not have the resources for me to get treatment. If it was not for the Global Fund, I would not be here now. They gave me the will to live. Here I am now. I can see my children grow up and I am a grandmother of two.”
Makukula, who now works for the Community Initiative for Tuberculosis, HIV/AIDS and Malaria in Zambia, said it was the free access to treatment that the Global Fund provided in Zambia that made the difference. “With support from the Global Fund, I was I was able to access free treatment. Before that support we lost a lot of lives because people could not afford the drugs. I was one of the lucky ones. I survived through those unfortunate times.”
What has also made a difference is early treatment, and North Carolina has had a huge role in making that an international protocol. Notes Ken Patterson, of the national anti-poverty group RESULTS, research conducted by Dr. Myron Cohen and his colleagues at the University of North Carolina School of Medicine has “proved essentially that treatment of HIV (with anti-retroviral drugs) is also prevention of HIV. When you put someone on treatment before they’re sick you can reduce transmission of that disease by 90 percent. Research coming out of North Carolina is really driving international standards for treatment.”
But continued treatment and thus prevention efforts depend on continued financial support. The Global Fund is seeking $15 billion worldwide to support even more ambitious and aggressive strategies to combat these diseases with the goal of saving 10 million lives.
We in the United States should take no comfort that most of the ravages from these diseases happen in other parts of the world. Not only are HIV/AIDS diagnoses continuing here but we face real risks from tuberculosis. Resistant strains of TB keep cropping up, and deaths do happen. A young Las Vegas mother and her infant daughter died just this summer from TB. Without constant research and vigilance, a pandemic is possible.
Organizers of the December Global Fund meeting are making a particular push for the United States to continue its commitment and pledge $5 billion over the next three years. That would amount to one-third of the Global Fund’s request. This effort has bipartisan congressional support. Both the Senate and House have put $1.56 billion in budgets for 2014.
The Obama administration should have no qualms with pledging its support. The U.S. has been a leader over the last decade in tackling these diseases. Now, when science and treatments are putting us at the precipice of eradicating these scourges, the world can’t afford for the U.S. to step back.
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