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Rights + Justice

The End of AIDS?

Not so fast, says Stephen Lewis. Beyond drugs we need social and political cures.

Tom Sandborn 23 Sep

Tom Sandborn has covered health policy and labour news for The Tyee for more than a decade. Starting this fall, he will be publishing commentary items on these beats, and he welcomes feedback and topic suggestions at [email protected].

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'We have a huge corner to turn': Stephen Lewis, former UN special envoy for AIDS in Africa.

It sounds like very good news. The United Nations announced triumphantly this summer, in the run up to yet another global conference on the disease, that it will be possible to see "the end of AIDS" by 2030.

The U.N. report claims that ending the AIDS epidemic by 2030 is possible and would mean the spread of HIV was being controlled or contained. The impact of the virus in societies and in people's lives will have been reduced by significant declines in ill health, stigma, deaths and the number of AIDS orphans.

According to a July article in the medical journal The Lancet, "in 2013 there were 1.8 million new HIV infections, 29.2 million HIV cases and 1.3 million HIV deaths as opposed to the epidemic's peak in 2005, when the disease took 1.7 million lives."

The Lancet also notes that anti-AIDS drugs have saved more than 19 million years of human life since 1990, 70 per cent of them in developing countries.

But Stephen Lewis says it's premature to declare victory. And he should know.

Lewis is the Canadian statesman, jocularly self-described "failed politician" and public intellectual who served the UN's Secretary General as special envoy on AIDS in Africa. He has founded both the Stephen Lewis Foundation and AIDS-Free World to battle the disease. Arriving in Vancouver last week to speak at a Wall Institute event, he sold out Vancouver's downtown Vogue Theatre.

Lewis said that inadequate international funding, the global reach of misogyny, which leads to policies that fail to deal with the impact of AIDS on women and girls (who are, he says, "at the centre of the pandemic") and a profoundly flawed effort by United Nations bodies (which he described as "pre-occupied with slogans") all suggest that the 2030 target is more rhetorical than realistic.

"We have a huge corner to turn," Lewis says in a podcast interview associated with the event (which you can listen to here).

"I'm not impressed, as others are, with the progress that has been made because it has been achingly slow," he told his Vogue audience. "We have lost millions of people whom we shouldn't have lost."

AIDS cripples communities that need healing

To have any chance of actually "ending AIDS," Lewis said, developed nations would need to increase funding for research and, very importantly, to expand the application globally of the "treatment as prevention" (also known as "test and treat") approach pioneered here in B.C. by Julio Montaner and his colleagues at the BC Centre for Excellence in HIV/AIDS. The impact of widespread testing and prompt treatment with anti-retroviral drugs is to reduce patients' viral load to nearly zero and to prevent person to person transmission, even in the event of unprotected sexual contact.

And it is not enough to simply provide every HIV positive patient with drugs, although that is hugely important, Lewis emphasized. The crippling blows already dealt to families, nations and economies by the disease will require investments that go beyond medicating patients to healing their families, communities and governments. Such investments in healing, Lewis underscored, should focus on supporting the crucial work already being done throughout sub-Saharan Africa by heroic "AIDS grandmothers," who are caring for the nearly 17 million children on that continent who have been orphaned by the virus.

"I am endlessly impressed and moved by the sophistication, knowledge and generosity of spirit I see among African women, which too often goes unrecognized in the West due to racism and misogyny," Lewis said.

What can Canadians do?

Asked by a Vogue audience member what Canadians can do to address the unresolved AIDS crisis he describes, Lewis suggested we support charities doing good work, especially those that reach out to the marginalized populations most vulnerable to HIV/AIDS, such as women and girls, men who have sex with other men, IV drug users and sex trade workers.

Sexist power differentials and the brute fact of rape's prevalence around the world mean that women and girls are often unable to prevent unwanted sex or to insist on safe sex precautions like condoms. "The nature of gender inequality is so entrenched that women ultimately suffer. They become the most vulnerable," Lewis said.

Supporting NGO and charity work in the field is a good idea, but as Lewis pointed out in his address, we should not let governments off the hook. Canadians can and should pressure the government to increase its investment in AIDS outreach at home and around the world, and put more money into programs that genuinely address gender power differences and support women's autonomy. We should also urge the government to move toward decriminalizing sex work, in the wake of the historic Bedford decision by the Supreme Court finding Canada's prostitution laws unconstitutional.

One more reason to support decriminalization of sex work surfaced this summer with the release of research conducted in part in Canada that suggests decriminalizing sex work could reduce HIV infections among prostitutes by 33 to 46 per cent.  [Tyee]

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