Inventing the end of AIDS is premature and dangerous
14 October 2014
A blog by Sisonke Msimang, editor and lead-writer of our new publication AIDS Today: Tell no lies and claim no easy victories.
We have reached a critical juncture in the story of AIDS. The headline news is that the world is on the brink of ending this enduring epidemic. Like many others who have dedicated their lives to battling this deadly disease, I hope this will be true one day. But this is no time for complacency.
There are still 35 million people globally who are living with HIV in their bodies. There are still daily assaults on the rights and dignity of women, girls and people who are gay, transgendered, sex workers, prisoners or drug users. And the structural drivers of inequality and injustice that have always shaped this disease remain firmly in place 30 years into this epidemic. The war on AIDS is not over yet.
In recent years, I have had many misgivings about the state of the AIDS response. I have watched with growing disquiet as the Joint United Nations Programme on HIV/AIDS (UNAIDS) has published its global report on the state of AIDS each year, increasingly taking on the voice of a cheerleader, applauding country efforts, commending progress and being the bearer of good news.
Last year’s UNAIDS’ report inspired a premature editorial in The Economist, asking, “How was the AIDS epidemic reversed?” For those of us who have fought AIDS and its devastating consequences for the last few decades, the question was inappropriate. I started talking with others about whether the strategy of good cheer wasn’t backfiring on the AIDS movement.
The consensus was that wealthy nations are under unprecedented pressure to demonstrate frugality and success to their citizens, and many international agencies know there is no longer an appetite for development failures. Funders are looking for ways to untangle themselves from AIDS commitments now that the virus no longer captures the imaginations of their citizens. For the policymakers tasked with pulling back, good news allows them to leave without looking fickle.
Organisations like the World Bank, UNAIDS, WHO and the Global Fund to Fight AIDS, TB and Malaria, having been the bureaucratic face of the fight against AIDS, are in a difficult position. On the one hand they understand the pressures of funders to reduce budgets and long-term commitment, especially as the deadline for the Millennium Development Goals (MDGs) approaches. On the other hand they work with vocal civil society organisations that argue that progress on AIDS depends on more resources, better funding and stronger political will.
At the same time, prices for the next generation of AIDS drugs are soaring, with many people failing to adhere to treatments because community follow-up systems are over-stretched and under-capacitated. In almost a dozen countries across sub-Saharan Africa, people are reporting having more sexual partners, and in some contexts, they report using condoms less frequently. In North Africa, Eastern Europe and Central Asia, infection rates are actually on the rise. We are still facing an epidemic that infects high numbers of women in sub-Saharan Africa, fuelled by women’s inability to exercise their fundamental right to choose if, where, when and under what conditions they will have sex.
AIDS activists like myself have to take some responsibility for predicament. For many years we perpetuated uplifting stories of hope and redemption in the fight against the deadly virus. Then we took the fight to the boardrooms, sipping lattes and sharing PowerPoints to convince leaders to act. We were caught napping after the 2008 financial crisis when donors began to withdraw, using concepts like “efficiency” and “sustainability” to cut programmes that were making inroads towards eradicating the disease. Maybe we lost sight of the bigger picture. The [messy] truth is that activists who have forgotten how to fight are part of the problem.
Beyond the MDGs, the argument over the next development framework is not about whether there is an AIDS goal or a set of indicators. If we allow technical wars to define our activism, we are playing a game we can never win. The lesson from the big wins and muting of the AIDS activist movement in the past few years is that timidity does not work. Moving forward we need a return to the basic principles that have always guided the fight against AIDS – the meaningful participation and representation of people affected by HIV and respect for basic human rights.
Inventing the end of AIDS is a treacherous mistake. The truth is that the end of AIDS is at once a heady promise and a fanciful invention of spin and hyperbole. This dangerous myth perpetuates the idea that there is simply a bit of unfinished business to tackle before the era of AIDS is behind us. We must challenge the new language of ‘success’ and ‘unprecedented scientific breakthroughs’ that have become the new AIDS orthodoxy. Maintaining vigilance is the only strategy that ever worked in the fight against AIDS. Anything less will signal certain defeat in the long term. In the words of Amilcar Cabral, “may you tell no lies and may you claim no easy victories.”
Sisonke Msimang works for Sonke Gender Justice in South Africa. A writer and an activist, she has worked with a range of NGOs over the past 20 years focusing on good governance, democracy, gender and AIDS.
This is an abridged version of a chapter from AIDS Today: Tell no lies and claim no easy victories, the first edition of a new biennial publication that presents the state of the civil society response to AIDS.