The speakers at the XIX International AIDS Conference in Washington DC are all talking about the possibility of ending AIDS, and the HIV response is being hailed as a shining example for other social interventions. But the reality is that resources for AIDS-related work are falling and international donor attention is focused on other issues.
How will this impact on countries still challenged by the HIV epidemic, such as my home country Ukraine where HIV prevalence is 1.6% among the adult population? I am left wondering what the consequences will be for the work of Alliance Ukraine and the many community organisations with whom we work.
In Ukraine, like many countries in Eastern Europe and Central Asia, the epidemic is driven by injecting drug use. Most HIV prevention programs are funded by international donors and implemented by civil society organisations. They have huge impact on the lives of thousands, such as Alyona who told her story to the Alliance for this film premiered at AIDS 2012.
Reduced resources in Ukraine will limit our ability to respond to HIV, leaving only fragmented access to limited anti-retroviral treatment (ART), which is currently funded by the Ukraine government. There will be no needle exchange programs for those most vulnerable to HIV, and methadone will not be dispensed – such unpopular measures are not attractive to politicians seeking votes.
There will be no treatment in prisons as this is currently entirely funded by the Global Fund to Fight AIDS, TB and Malaria, which is also struggling to maintain international donor support in the current economic climate.
The reality behind the end of AIDS
Any withdrawal of community projects that reach hidden populations such as people who use drugs, sex workers and gay men will mean more people will not show up for testing. As a result, the HIV prevalence rates will come down and the government will proclaim the end of AIDS. But this will not be a true end of AIDS.
Do we really want to be caught out by this illusion? Shouldn’t we have learnt from countries such as Russia who have consistently underestimated the scope of the problem amongst their most at risk populations and have ended up with an explosion of HIV infections and other governments that are severely underestimating the number of people who are more at risk of HIV to cap the amount of money going into their response?
Amidst all the optimism of an AIDS-free generation, I sense danger. Danger that some governments will stop acknowledging the needs and rights of those who are most at risk of HIV. Danger that the effective community responses we have built up over many years of hard work, and with the significant investment by international donors, will falter. Danger that the excitement, which many feel over new scientific advances in HIV treatment, will blind people to the need to continue to invest in and strengthen community-led responses. We must NOT stop now!
Tanya Deshko has been awarded the Levi Strauss Pioneer Award at International AIDS Conference in Washington DC for her outstanding contribution to fighting HIV and AIDS in Ukraine.