Two cheers for lower HIV incidence
Of course, any story of a steady march to epidemic control is likely to conceal less triumphal elements. UNAIDS itself admits that while it is committed to reducing the human rights abuse (particularly in regard to women and other vulnerable groups) that often accompanies HIV infection, there is no sense that we have seen equally substantial reductions in violence against women and children or in excessively punitive laws against injection drug users. And there is more: while UNAIDS cites successes, it does so selectively: the infection rates among men who have sex with men has not deceased over the last decade, to the contrary. Why, ask gay rights groups, is this not emphasized in the press releases? Do the rising infections of gay men matter less than the lowered HIV acquisition among kids and non-gay men? In addition, only a percentage of those in need of HIV treatment in low-income countries are receiving it, and much needs to be done to get close to universal coverage.
As I have mentioned before, the vast numbers of HIV-positive persons on antiretroviral therapy worldwide is an amazing, fragile and contested achievement. Amazing, because there is almost no historical precedent for the magnitude of efforts and funds thrown at this particular disease. Fragile, because if the money streams to keep millions on this lifelong life-saving therapy dry up, and there is a massive treatment interruption, all (possibly drug-resistant) HIV will break loose. Contested, because it is hard not to notice that the investment in HIV/AIDS is disproportional to what is devoted to other diseases that produce similar or worse morbidity and mortality numbers. There is, of course, no ethical way of going back. Just ethically messy ways of pushing forward.