Wednesday 1st December marks the world's 24th commemoration of World AIDS Day. With Australia having only recently recorded our 30,000th positive status in more than 25 years of testing it's worth pausing to remember the magnitude and complexity of the global pandemic that has claimed roughly 30 million lives in three decades. More critical is the reminder of the hopeful nature of the response that can be achieved with greater focus and collaboration.
For me AIDS switched from being list of horrifying stats from far off places to something very real when I met Princess Kasune Zulu through World Vision in 2002. One of few people in southern Africa who'd admit to being HIV positive, she was on a one woman mission to warn the world about the pandemic. It wasn't long before I was absorbed in the fight, travelling through her homeland Zambia and neighboring countries preparing to write a book that would come to be known as Warrior Princess, documenting the story of her life and in turn the story of AIDS.
This travel brought home the realisation that the lottery of latitude dealt me a winning hand. My life had followed avery different course to Princess, who had lost her parents and baby sister to the virus and had become infected herself, simply because I had been born in Australia.
It sticks in my mind that most African native languages have no word that equates to the English, orphan. The extended family, the village, was there to embrace any child whose biological parents passed. Today, not only is the word orphan common place, but so too is another more melancholy term, serial orphan. This term describes a child whose parents have died and who has then moved from carer to carer each perishing from a virus that many describe as the greatest moral challenge facing our generation.
The reasons for the prevalence of AIDS in southern Africa, home of two thirds of the world's HIV infections, are worth exploring - partly to help us understand the complexity of the response required and also to dispel the myths and prejudices that lurk atthe back of our minds.
The primary reason AIDS was able to take hold lies with its deadly ally, extreme poverty. With too many of southern Africa's number living on the Australian equivalent of less than $2 per day families have scarcely enough money for one or two daily meals.On that kind of income, even the most basic medical care and education remainselusive.
Historically, the impoverished medical system itself has played a lead role in enabling the spread of the virus. Take a country like Zambia. In 2002 there were just three HIV testing centres across the country and each HIV test cost $3. If you live onless than $2 a day - transportation to the testing centre is prohibitive, before you even contemplate the cost of the test. Historically, the medication to treat HIV cost up to $10,000 annually. A positive diagnosis was simply a death sentence, so why would you fight so hard to find out in the first place?
Part of the reason the medical system is a crumbled mess lies with international lenders who imposed conditions on countries with excessive borrowings that preventedany more than 5% of GDP being spent on a country's civil service - this meansdoctors, nurses and teachers. When the health of a nation is so perilous, medical care must be obtained somehow. A country like Zambia with less than 1000 'western' medical doctors for a population of 11 million people instead relies on its 40,000 'traditional healers' for medical care. These healers, who were slow to believe in HIV and AIDS, remain the primary carers of their destitute, remote populations. Rather than diagnose HIV, all too often they made pronouncements of witching and curses and prescribed treatments such as sleeping with a virgin girl or cuts with dirty razor blades to cure one's ills.
Next we are faced with challenges of geography, Zambia is a landlocked country bordered byeight neighbours, all similarly poor. Historically roads have been in terrible condition - I have seen children walk along ahead of a car and offer to fillpotholes with a bucket of soil for money. It takes an inordinately long time topass from one side of the country to the next and then more days still to clear its borders. With less than sea five ports to the whole of Africa, the transportation of goods by roads is a necessity. The reality of women living through desperate times is a pressure to resort to the provision of sex for money just to survive. There's always a ready assortment of girls at African border posts waiting for weary drivers who have been away from home for months. Many of these girls have been orphaned by AIDS themselves. Sexual interactions cancome as cheaply as $1 or $5 if a man doesn't want to wear a condom.
Social structures have also enabled the HIV to spread. Up until and including 1997when Princess Zulu wanted to be tested, women needed the permission of their husbands. When condoms are available, women are often powerless to insist they are used in cultures so dominated by men.
The HIV virus also gives itself a running start in southern Africa. The region is home to aparticular strain of HIV that may take 8-10 years to exhibit physical symptoms after infection. By this time the virus can spread from person to person from community to community and country to country with no one realizing.
The truth of the matter is a perfect storm of conditions joined forces to effectively laydown a red carpet for this insidious virus, allowing it to silently infect ageneration of the region's most productive members before they ever even knew what hit them.
The response required to undo such a tangled web is equally complex, though by no means impossible.
Partially at the encouragement of Princess Kasune Zulu on her visit to the Whitehouse in 2005, the international community pledged to provide treatment to all who require it, a commitment known as the provision of Universal Treatment. A key element of the response, this was the right and only decision to take. However, this pledge has myriad consequences. On the upside, 5 million people in developing countries now receive life saving treatment. On the downside, for each two who gain access to treatment another five become infected.
The financial costs of providing universalaccess to treatment are high, with over 80% of the cost incurred not from the medication itself, but from the infrastructure: the testing centres, doctors and hospitals essential to administer the complex cocktail of drugs currently available.
The result is an exponential increase inpeople requiring treatment at an ever-increasing cost. Much of the US government's international aid budget is currently consumed by the provision ofAnti Retroviral Drugs (ARVs), while essential and right, this is money tha cannot be spent on education other aspects of health reform or infrastructure.The budget cannot be reduced as once a person commences ARVs they must continue the regime for life, lest HIV progress to AIDS.
While the international humanitarian agencies continue to argue for governments to increase all forms of Overseas Aid, we must recognize the response is not the responsibility of governments alone.Countries like Uganda, and to a lesser extent Zambia, have shown that the tidecan be turned on HIV. Uganda's world famous success story saw governments,humanitarian organisations, churches, community groups and schools unite to reduce infection rates from around 20 percent to five percent.
When we hold the virus firmly in our sights we can win. The number of new cases of HIV/AIDS has dropped by about one-fifth over the past decade.UNAIDS has plans in place to eliminate the passing of the HIV virus from mother to child during childbirth or breastfeeding by 2015. The cost of the drug required to achieve this outcome is a meager four dollars. Earlier this year UNAIDS released a report entitled Treatment 2.0 that advocates for a new, less expensive treatment regime that can be administered by nurses, at a greatly reduced cost and with reduced side effects. We now know that if people can begin accessing treatment before they are on death's door, it can also prevent the spread of the virus.
The best scientists declare both cure and vaccine to be some way off. While they pursue these most important of goals, the moral challenge before each of us isnot to turn our heads, but to retain hope and to unite and innovate. The solutions are there, they require an un-precendented level of commitment and collaboration and a focus on that which no longer makes headlines.
While Australia remains far removed from the epicentre of this storm we must hold it at the forefront of our minds. The spread of AIDS means the erosion of decades of progress in development.
When we need a reminder as to just why this is so important, take a looks at a group of Aussie kids playing together be they your own children, your neighbours' children, nieces, nephews, or grandchildren - imagine for a moment one in three has tragically nursed their parents to their early death. Imagine the term 'serial orphan' applying to our own. Imagine Australia's sons and daughters living alone at eight year, 10 years, hungry and frightened, trapped in a cycle of precarious vulnerability and extreme poverty. If we wouldn't allow this to happen here, why is it so much easier to tolerate on the opposite side of the world?
To mark World AIDS Day 2010, GPP Australia are giving away 5 signed copies of Belinda & Princess's book Warrior Princess.