Last week we learned that a baby was cured from HIV by treating the infection early. More than 10 years of investments in HIV research have led to major scientific breakthroughs. The Investment Framework, published in the Lancet (2011), outlines a model that shows it is possible to halt the epidemic if targeted investments are made by 2020. These advances show that we can end AIDS in a generation.
Sweden is playing an important role in various post-2015 development framework processes. Sweden’s Minister for International Development Cooperation, Gunilla Carlsson, is a member of the UN Secretary-General’s High-level Panel on Global Sustainability (GSP) and Sweden is co-hosting with Botswana a thematic consultation on health for the post-Millennium Development Goals (MDGs) process. The question is whether and how HIV will continue to be included in the future development framework. Losing a specific HIV goal now may risk undermining the investments already made.
As we approach 2015, the development sector has reflected on the MDG processes and their value. The development of the current MDGs has been criticized for the use of a top-down approach, which has hindered country ownership. The lack of a human rights perspective in the MDGs has been seen as a limitation. According to critics, separate MDGs have also resulted in an uneven approach to health and development. On the other hand, the MDGs have proved to be an unprecedented vehicle in mobilising funds and political commitment for development and ending poverty. It is against this background that advocates are calling for a continuation of health-related MDGs, which will not be met by 2015. But how do we ensure a strong HIV response in the future? This question was the focus of a roundtable discussion organised by the Alliance and MSF on Valentine’s Day in Stockholm.
The event highlighted a complex debate about how development should be funded and approached in the future. Sweden’s Health Ambassador Anders Nordström argued that middle income countries needed to take a greater responsibility for funding their own HIV response using domestic resources. The Alliance’s Executive Director, Alvaro Bermejo, stated that although some middle income countries have the means to increase their own in-country funding to tackle HIV and AIDS, political will was lacking. World Bank income categories also fail to reflect wider socio-economic disparities within these countries.
A wider approach to health was discussed as a way forward. The global development discussion tends to focus on aid, but it is time to move away from aid. Kristina Bolme Kuhn, President, MSF Sweden, said “it is not about aid, but about the costs needed to eliminate the disease”. The US$22 billion needed is a relatively small cost, which can be shared. It is therefore neither conducive nor realistic to argue that there are not enough resources to cover the costs needed.
It remains to be seen whether donors and countries have the political will to invest in HIV and AIDS and are able to commit to creating a more viable legal environment for people affected by HIV. Legal barriers such as criminalization of HIV transmission and behaviours which put people at higher risk were only mentioned briefly at the roundtable. Yet, criminalisation of drug use, HIV transmission and purchase of sex services create significant barriers to an effective HIV response in Sweden as well as in many other countries.
Only when there is long term investment and commitment to law reform, can an end to AIDS be achieved.