Sara L.M. Davis
The International AIDS Conference opens today in Amsterdam, with up to 19,000 scientists, activists, and officials coming together from around the world. The world has come a long way since the last time the meeting took place here, in 1992, with old and new challenges on the horizon.
In 1992, an old world order was giving way: South Africa was dismantling apartheid, Russia was an emerging democracy, and the European Union was newly founded. HIV was a global crisis and fast becoming a leading cause of death, with an estimated 1.5 million cases. Twenty-six years later, although there are an estimated 36.9 million people living with HIV globally, the world has become complacent about the epidemic. That’s in part because of widely available antiretroviral treatment, and global institutions that fund and distribute treatment and prevention in low resource countries.
But delegates and activists gathered here in Amsterdam say a crisis is imminent as a result of donor withdrawal from middle-income countries in Eastern Europe and Central Asia; human rights violations driving transmission among key populations; and cases on the rise among hard-to-reach young people. All this means, according to UNAIDS, that HIV is at risk of becoming a resurgent global pandemic.
HIV financing has flat-lined
Reports launching this week will say that global HIV financing has flat-lined, with between $14.55 and $18 billion needed, but donors increasingly threatening to withdraw from middle-income countries. The European location of the conference will be a chance to shine a light on the recent spike of HIV incidence in Eastern Europe and Central Asia (EECA), especially in Russia.
Global HIV donors want to shift their funding to high-burden countries in Africa, arguing that the governments in EECA and other middle-income countries have a responsibility to allocate more funding for health. Activists here are challenging the Global Fund to Fight AIDS, TB and Malaria (the Global Fund) and the US President’s Emergency Fund for AIDS Relief (PEPFAR) to commit to funding stigmatized and criminalized key populations everywhere.
At the day-long Global Dialogue on HIV and the Law, Ukrainian harm reduction advocate Andriy Klepikov said there are over 300,000 key populations in a Global Fund-financed program who face a risky transition process next year: “Whose responsibility is it to fund key populations? Both sides have a responsibility. If you’re giving something and I’m taking something, it’s our mutual responsibility not to drop it on the floor.” The Global Fund’s chief of staff, Marijke Wijnroks, defended their record in Ukraine, saying there is a tough set of challenges in getting funding to those who need it in Russia and EECA, given restrictive laws on foreign financing, closing space for civil society organizations, and punitive laws and practices driving key populations underground.
Youth at growing risk
The Duke of Sussex, Prince Harry, is attending AIDS 2018, marking another milestone. In 1992, Prince Charles and Princess Diana were in the process of separating. This week their newly-married son is meeting with young African AIDS advocates, as part of the conference’s emphasis on youth. A separate Youth Programme is bringing together adolescent and youth activists to promote their work, share experiences and coordinate advocacy for human rights. HIV is on the rise among young women in many countries, and UNAIDS says that progress in fighting the epidemic among children has slowed. The involvement of young people in the response is increasingly critical.
Three decades into the history of AIDS, veterans are passing the torch to a generation facing new problems and challenges. Justice Michael Kirby spoke at a pre-conference international meeting of activists representing people who use drugs, over one third of whom said they were attending their first international AIDS conference. Pointing to how hard it has been for people who use drugs to come out in the public eye, he remembered the early days of the epidemic, when LGBT activists like himself first came out. “Always remember the words of Winston Churchill,” he told the group. “Never give up, never give up, never give up.”
Sara L.M. Davis, Ph.D. (aka Meg) is an anthropologist and writer. Her forthcoming book is The Uncounted: Politics of Data in Global Health