HIV and AIDS response failing to keep pace with an evolving disaster

Published: 26 June 2008 0:00 CET

This year’s World Disasters Report is the first to focus on a single condition and for very good reason. HIV and AIDS is evolving not only as an aggravating factor in disasters but also as a disaster in itself.

Of the 201 million people affected by natural disasters during 2007, a 40 per cent increase on the previous year, those suffering from HIV were among the hardest hit.

The disruption of medical supplies and subsequent interruption of treatment is evidently life threatening. . Malnutrition speeds up the progression of HIV. Lack of clean water for food preparation and personal hygiene is especially dangerous for those with advanced HIV. In a disaster, HIV prevention programmes are often disrupted and populations at higher risk of infection  are forgotten.

However, it is the epidemic itself that is most alarming. The United Nations estimates that last year alone some two million people died from AIDS - bringing the total death toll to more than 25 million since the first cases were reported in 1981.

For countries in sub-Saharan Africa that have seen their societies torn apart by the virus or the numerous marginalized groups of people around the world who have been left to cope with death, disease and destitution, HIV and AIDS is undoubtedly a disaster.

Yet it is a disaster to which the world is still struggling to respond. The United Nations estimates that a further 2.5 million people - nearly seven thousand people a day - contracted HIV last year. Of the seven million people estimated to need anti-retroviral treatment, which can delay the onset of AIDS, some five million still do not have access to these drugs.

The bottom line is that our response to HIV is failing to keep pace with the complexity of an evolving disaster.

For Southern Africa, where at least one in ten adults is now living with HIV, the long-term effect on childcare, education and health can be devastating. In South Africa, one in five young teachers is living with HIV, and in Botswana, almost as high a proportion of the health care workforce has died of AIDS since 1999. In Sub-Saharan Africa as a whole, some 12 million children are now orphaned as a result of AIDS. The International Monetary Fund has warned that entire nations risk a downward spiral into subsistence economies in three or four generations.

Yet far from recognising the long-term implications of this situation, official development assistance for health training and personnel development has actually dropped by 36 per cent to just 0.6 per cent of all development spending.

In terms of causes, there has been a failure to tackle the long-term effects of stigma and discrimination - particularly in parts of the world where HIV prevalence is concentrated rather than society-wide. Yet despite what we know about high-risk groups, only one in ten injecting drug users and men who have sex with men, and fewer than one in five sex workers, have access to HIV prevention services.

Stigma doesn’t just affect the high-risk groups. By preventing people from being tested for HIV it also increases the risk of transmission. Stigma leads to the rejection of children orphaned by AIDS and to women being chased from their homes even if their husband infected them in the first place. The results of inaction can be seen in regions where HIV prevalence has traditionally been low. For many countries in Central Asia, Eastern Europe and South East Asia, HIV rates are now on the rise.

The response to HIV and AIDS has also been complicated by the vast number of people who are now on the move around the globe. The International Organisation for Migration estimates that there will be some 200 million migrants in 2008.

Whether driven by conflicts, economic inequality or natural disasters, the movement of people within and between countries is exposing many to greater risk. But it is not always those we expect. For example, with many people moving from regions of low to high HIV prevalence, the idea that migrants are the spreaders of HIV has been exposed as a myth.

This year’s World Disasters Report makes it clear that a more effective response to HIV  will need to be longer term and better targeted with delivery being more inclusive and better coordinated. A longer-term approach means recognising the implications of a disease with a latency period between infection and death of 15 years or more.

In regions with high HIV prevalence like Southern Africa, the long-term impact on education, health, childcare and economic development implies a move from short-term ‘fixes’ to one of sustained treatment, capacity building and the strengthening of the resilience of local populations.

Worldwide, a long-term approach is also needed to address the root causes of vulnerability. These include stigma and discrimination against marginalized groups, gender inequality and grinding poverty.

Better targeting means making sure that people living with AIDS and those most at risk are at the centre of any response - whether they be women, migrants, men who have sex with men, sex workers or injecting drug users.

It also means recognising that the epidemic varies from disaster to disaster and from country to country. ‘One-size-fits-all’ responses that ignore whether the disease is generalised or concentrated or what stage a disaster is at are destined to fail. Overall, there is a clear need for further research and a greater insistence on evidence-based, results-driven programmes.

In terms of delivery, a more inclusive and coordinated approach means more involvement and empowerment of local communities, less tied and earmarked aid, greater integration of HIV into all aspects of humanitarian work and a simplification of bureaucratic processes for obtaining and delivering aid.

The challenges are enormous - but if we fail to meet them, there will be little chance of reversing the spread of one of the most deadly viruses in history.