Global AIDS Policy in the Age of Obama

An excerpt from my piece in the Journal of HIV/AIDS and Social Services

This editorial is based on a short trip I took to South Africa earlier this year.
April 2009

In 2006, then-U.S. Senator Barack Obama and his wife Michele traveled to Kenya, Obama’s father’s homeland where many of the senator’s extended family still lived. The Obamas publicly took an HIV test during their trip, an important moment as sub-Saharan Africa is the region most affected by the HIV/AIDS crisis, with more than 2/3 of the world’s infections.

For every outspoken leader on HIV/AIDS like Uganda’s Yoweri Museveni, there have been as many or more AIDS denialists like South Africa’s former president Thabo Mbeki and his shamefully ignorant health minister Manto Tshabalala-Msimang who at one time suggested that beetroot and garlic were effective treatments for HIV. Given the new U.S. president’s Kenyan heritage, Barack Obama may be uniquely placed to speak to the African people about the dangers of HIV and steps they can take to protect themselves. While Obama may have this special connection, larger currents will constrain his ability to advance the fight against HIV, a product of both the positive and negative legacies of the George W. Bush administration….

Given that there is no cure for AIDS, the extension of treatment to those who are HIV-positive is perhaps a deeper responsibility than people realize. Donors assume moral responsibility to extend ARV therapy for the remainder of those people’s lives.  Repudiation or interruption of that commitment would be extremely damaging, as those people would die unless the cost of treatment were picked up by some other donor, the person’s government, or the individuals themselves. Of course, people who never receive treatment will also die, but it would be even more unseemly to extend treatment only to later take it away. Before the donor community continues the practice of putting people on treatment when they are already quite sick, leaders should re-evaluate the efficacy of those efforts.

At the same time, it would be a tragedy if the global community decided to “walk off the field” by allowing their attention to lapse or stray. Nearly a decade into the world’s ambitious effort to address the AIDS pandemic in the developing world, there is a great danger that the financial crisis, other priorities, and the continued spate of new infections will cause donors to lose heart. The Obama administration should seize the moment to infuse the donor community with a new sense of purpose, focusing on the most promising avenues to reduce the rate of new infections. That would be change we could believe in.

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