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Gus Cairns
Published: 15 July 2012

Does the world have the political will to end HIV? This isn’t a rhetorical question. We could probably do it.

We have eradicated one disease, smallpox, while another, polio, is nearly gone. By using vaccines, you will point out, something we don’t have against HIV. True: but these are highly contagious diseases, spread with a touch or a breath, like that other epidemic we have so far failed to contain, tuberculosis.

HIV is, on the other hand, hard to catch and if someone takes the treatment for it, they can become, to all intents and purposes, non-infectious. Modellers show that if you could test people often enough, diagnose them soon enough, treat them fast enough, you could get to the crucial point where the average person with HIV has a less-than-50% chance of infecting  anyone else in their lifetime. 

Yet HPTN 052, the study that finally proved that, arrived just at the wrong time: a couple of years into an economic crisis in the rich countries which have funded HIV treatment. A potential disaster; history shows this virus can mount a rapid comeback if the pressure is taken off.

The answer, as Laura Gonzalez Lopez finds out in Will the world pay up to end HIV?, may partly lie in new ideas like the ‘Robin Hood’ financial transaction tax, which would skim off a tiny percentage of bankers’ profits. But it also lies in countries with expanding economies and significant local HIV problems taking more responsibility for containing their epidemics and those in neighbouring but less well-resourced countries.

The reason they don’t is partly due to massive economic inequality between rich and poor. It’s also partly due to political corruption and healthcare systems unsuited to dealing with the multifactorial causes of HIV. (This hasn’t, though, held back South Africa or Brazil, two of the most economically unequal countries in the world.)

But it’s also to do with stigma. A number of the countries with the worst HIV problems also have the worst records of stigma and discrimination against groups most vulnerable to HIV.

Russia, for instance, is still vehemently opposed to a harm-reduction approach to HIV and hepatitis prevention in injecting drug users. The Global Commission on Drug Policy is only the latest body to have critiqued this approach as counter-productive.

But the stigma that it’s probably most crucial to address is that against men who have sex with men (MSM). As we are reminded in The gay globe, there is a resurgent HIV epidemic in MSM in a lot of countries where HIV in other groups is either declining or was never that common.

This is largely caused by growing opportunities to observe, connect with and emulate gay role models and lives, but in some countries this is meeting violent opposition from conservative societal and religious cultures – making it hard or impossible to develop MSM-specific prevention or treatment services. At this pivotal moment, it’s vital to get across that public health is not served by criminalising gay men. We have to confront homophobia if we are to defeat HIV.


Together, we can make it happen


