Whatever Happened to AIDS?

Lady Gaga

PULSE readers may not have noticed but Lady Gaga is dead. Justin Timberlake is dead. So are Alicia Keys, Elijah Wood and a host of other celebrities. Well not literally dead – ‘digital death’ is what they call it. This past Wednesday, on World AIDS Day, all of these people have seized communication with the outside world through their Twitter and Facebook accounts. (Some lower-caste people too have joined the invitation to commit digital suicide.) The basic aim is to raise money for Alicia Keys’ Keep a Child Alive charity. Only after fans have donated one million dollars to the cause, will the celebrities revive their digital lives.

It’s a great bargain. For as little as $10 not only will you not have to suffer the void in your everyday life of not “knowing where they are, what they had for dinner, or what interesting things are happening in their lives”, at the same time you buy yourself into a community that saves millions of lives and “give[s] millions of real people the care, love and hope they deserve”.

Do “what you always do”, says Keys, and save a few Africans.

It is of course easy to be cynical about her campaign, just one of many such corporate-celebrity schemes – think of Bono’s Product (RED), Fashion Against AIDS, Live8 – which have chosen the African AIDS epidemic as their cause celebre, tapping into the charitable impulses of the privileged consumer. The most immediate flaw of the campaign is of course that a million dollars will most certainly not alleviate the suffering of millions of people living with HIV. But that is beside the point. Much more important is the way Keys’ gambit feeds into and reproduces the kind of liberal-humanist discourse of AIDS that has become so pervasive in popular culture in recent years. To be sure, as Paula Treichler has argued:

“no single view of the epidemic has done more important cultural work: the call for compassion and caring has served important social ends, asking citizens to rise above prejudice, discrimination, and fear and help the suffering.”

But important as this narrative may have been in directing the attention of the privileged few in the North to the suffering of people living with HIV in their own communities and the global South, the question is at what cost? For, Treichler continues, “no other single view” of the epidemic “is so overarchingly irrefutable, so unreflectingly embraceable, or so glibly deployable in short-circuiting discussions of structural inequalities, politics, and economic needs” as that which reduces the AIDS crisis to a matter of charity [1].

The fundamental problem lies with the thoroughly depoliticised image of the epidemic that is implicit in the campaign’s message. An image which displaces attention away from the way we and our governments in the North – exactly by doing “what we always do” – are directly implicated in the structural violence of the global neoliberal order, which systematically violates the basic human right to health of the most marginalised peoples – the poor, young women, children, drug users, gays, sex workers – and thereby contributes to the strikingly unequal distribution of the disease.

AIDS IS NOT IN RECESSION

There is no doubt that incredible progress has been made over the past decade in tackling the global HIV/AIDS pandemic. The number of people in the Global South receiving life-saving antiretroviral therapy (ARV) has risen from a mere few thousand in the late 1990s to more than 5.2. million today. In Botswana, one of the world’s poorest countries where every fourth adult is HIV positive, antiretroviral therapy coverage now exceeds 90%. Global AIDS-related deaths among children have fallen by almost a fifth between 2004 and 2009. Huge advancements have been made in the prevention of mother to child transmission of HIV and for the first in the history of the pandemic the infection rate is slowing down.

At the same time, over the course of 2009 alone, 1.8 million people have died, 1.3 million of which in sub-Saharan Africa, raising the total death toll of the pandemic to more than 30 million. 2.6 million people contracted HIV during 2009, bringing the total to around 33 million. That means that for every person put on treatment, two more become infected. This year was set as the deadline for meeting the target of universal access to treatment by G8 countries at the 2005 Gleneagles summit, yet 10 million people, more than 60% in sub-Saharan Africa, have no access to ARVs. Though southern African countries remain the hardest hit, latest figures from Eastern Europe and Central Asia show distressing rates of infection amongst drugs users and sexworkers. In Russia, 37% of the 1.8 million people who inject drugs are estimated to be HIV positive. In some cities in the Ukraine that rate is as high as 88%. The brutal criminalisation of drug users by governments is only further fuelling the spread of the virus and depriving people of access to life-saving therapy – AIDS-related mortality in this region has quadrupled since 2001 [2].

Clearly then, despite the positive spin of the latest UNAIDS report, AIDS is not recession. What is more, much of that progress that has been achieved is now facing a double blow. Over the past year, Medicines Sans Frontieres (MSF), Health Gap and others have been sounding alarm over the retreat of donor countries from AIDS funding. The fickleness of western humanitarianism was amply illustrated only weeks after Nick Clegg and other leaders had pledged their heartfelt commitment to the Millennium Development Goals (MDG) at the UN Summit in September, when donor countries had failed to meet even the worst case funding scenario of The Global Fund for AIDS, Malaria and Tuberculosis – the largest multilateral investor in the fight against AIDS. Donors pledged $11.7 billion, just over half of the $20 billion the Fund had requested to scale-up treatment and prevention programmes.

Just last week, the Dutch government announced it is reducing funding for AIDS NGOs. Austria – the 11th richest country in the world – has pledged a total of $0 to the Global Fund since 2002, despite hosting this year’s International AIDS Conference. It has just announced further cuts to its aid budget. Sadly, this is nothing new – the fight against AIDS has always been plagued by “a disturbing gap between how much is being given and what is projected to be needed to fights HIV/AIDS effectively” (Rowden, 2010, p. 10).

Many governments are now using the current economic crisis as an excuse to retreat from AIDS funding to areas which offer more “value for money” – the latest new catchphrase in development-speak. In its May 2010 report, MSF notes that it is witnessing the return of the very same technical discourse of ‘affordability’, ‘cost-effectiveness’ and ‘sustainability’ with which the World Bank, USAID and other northern development agencies had rationalised their refusal to roll-out treatment programmes in ‘resource-poor settings’ in the early 2000s. The bitter irony here is that the supposed lack cost-effectiveness and sustainability of health care delivery in ‘developing’ countries is largely the product of the economic programmes forced upon the South by these very institutions since the early 1980s. Much has been written about the devastating socio-economic impact of World Bank/IMF structural adjustment programmes throughout Africa – most recently by Rick Rowden in his excellent book The Deadly Ideas of Neoliberalism – but few people are aware that the IMF’s continuing adherence to neoliberal orthodoxy effectively blocks aid-dependent countries from scaling up health expenditure despite the massive increase in global HIV/AIDS funding since 2001. The idea is that this would upset the recipient countries’ ‘macroeconomic stability’. The lesson is clear: in the neoliberal age, economic dogma trumps the human right to health.

There are already alarming reports coming out of several sub-Saharan African countries of patients demanding AIDS treatment being turned away at the doorstep of local clinics and doctors having to resort to a rationing of treatment due to stockouts and many fear worse is to come. A new person is enrolled only when someone else dies. According to one study, Obama’s current flat-lining of funding for PEPFAR – the mutli-billion AIDS emergency scheme set up by the Bush administration in 2003 – is estimated to “result in 1.2 million avoidable deaths in the next 5 years in South Africa alone”[3], but one example of the “Pavlovian betrayal of the South” that so routinely provokes absolute silence from the commentariat.

The second blow to the fight against HIV/AIDS is the emerging threat to the flow of cheap generic AIDS medicines, which has brought down the cost of first-line treatment to less than a dollar a day per patient. But as patients develop resistance, they need to switch to more powerful second and third-line drugs, many of which are already patented in the countries which have the capacity to produce affordable generic copies. As a result, the price of these newer drugs is in some cases several hundred times higher than their first-line predecessors.

The future of generic production of AIDS drugs now lies in the hands of European and Indian trade officials, who are busy negotiating the EU-India Free Trade Agreement. According to MSF, the trade deal contains a number of intellectual property rights (TRIPS) provisions which threaten to cut off the life-line of cheap drugs coming from India, dubbed by some as the ‘pharmacy of the world’ as it currently supplies the vast majority of affordable ARVs (and other essential medicines) to the developing world. In addition to these so-called TRIPS+ rules, Big Pharma is heavily lobbying for new legislation which attempts to blur the line between generic (i.e. legal) and counterfeit (i.e. illegal) medicines. And their strategy is already reaping some success: over the past few months, police authorities have seized and delayed several shipments of generic medicines in transit through Europe destined for Africa.

Again, this is nothing new. During the last decade, wealthy governments acting at the behest of the pharmaceutical industry have been actively preventing countries from accessing and producing their own cheap medicines. But with millions of people on treatment, the current efforts to further strengthen the irrational global intellectual property rights regime threatens to return us to the “days when unconscionably high prices for antiretrovirals (ARVs) condemned many to death simply because they could not pay for life-saving medicines that were widely available in the developed world.”

THE NORMALISATION OF AIDS

Some time ago, Jeffrey Schmaltz wrote in The New York Times Magazine:

“Once AIDS was a hot topic in America — promising treatments on the horizon, intense media interest, a political battlefield. Now AIDS has become normalized, part of the landscape. It is at once everywhere and nowhere, the leading cause of death among young men nationwide, but little threat to the core of American political power, the white heterosexual suburbanite. No cure or vaccine is in sight. The world is moving on, uncaring, frustrated and bored, leaving by the roadside those of us who are infected and who can’t help but wonder: Whatever happened to AIDS?”

That was November 28, 1993, two days before Schmaltz died of his illness, a time when deep despair and cynicism was taking hold of the HIV+ community in the US.

We are now reaching full circle. “Aids has finally gone out of fashion, almost 30 years after the pandemic began. It is no longer front-page news”, writes Sarah Boseley of the Guardian, perhaps the only UK journalist who doesn’t need a Bono press event to consider AIDS a newsworthy issue. “There was a time when Europe and the US had to be seen to help the millions who were dying of an incurable illness in the developing world, but with some stability evident in the pandemic and a gradual decline in the death rate” that is no longer the case.

As the AIDS crisis falls of the news media’s radar and the legacy of World AIDS Day becomes usurped by vacuous corporate-celebrity schemes, it is important to remember that much of the progress in breaking down the wall of global medical apartheid is owed to the mobilisation of an extraordinary North-South coalition of AIDS activists since the early 2000s [4]. It was South African campaigners who broke inhumane patent laws by ‘illegally’ importing cheap generic drugs from abroad, at a time when the coffin industry could barely keep up with demand. They took on the monopoly power of the pharmaceutical giants to charge prices of well over $10 000 per patient a year in countries with annual per capita health expenditures of less than 25 dollars. It was MSF’s project in the poverty stricken township of Khayelitsha which blew apart the myth that treating the poor is unaffordable or unfeasible. It was Health Gap and other groups from around the world who challenged the complacency of rich governments and obstinate international bureaucracies, forcing them to commit the financial resources necessary to kick-start national treatment programmes throughout sub-Saharan Africa. But, perhaps most importantly of all, it was the global AIDS movement which exposed the moral economy at play in an order which so arbitrarily determines who should live and who should die of the disease.

The world has indeed gone a long way in the fight against AIDS but much of that is now in danger of being undone – a condition that no amount of shopping, tweeting or dead celebrities will redress. As AIDS becomes normalised and the suffering of millions subsumed by the perverse logic of commodity fetishism, a hierarchy of human life re-emerges and the people in the Global South living with HIV/AIDS are once again relegated to mere homines sacri – subjects whose lives can be effaced without a trace at the whims of Empire.

Notes:

[1] Paula Treichler (1999). How to Have Theory in an Epidemic. p. 317

[2] In the United States, in March 2009 Washington DC reported an HIV prevalence of at least 3% among people over 12 years – similar to rates in some parts of sub-Saharan Africa – 76 % of whom are African American. Facing a chronically underfunded AIDS Drug Assistance Program (ADAP), hundreds of Americans are currently on treatment waiting lists.

[3] Walensky, R. P. & Kuritzkes, D. R. (2010). The Impact of the President’s Emergency Plan for AIDS Relief (PEPFAR) Beyond HIV Why It Remains Essential. Clinical Infectious Disease.

[4] Smith, R. A. & Siplon, P. D. (2006). Drugs into Bodies. Global AIDS Treatment Activism.

Please sign MSF’s petition ‘Europe! Hands off our Medicine’: https://action.msf.org/en_CH

If you happen to be in Brussels on Friday December 10, join MSF’s protest against the EU-India FTA. (For more info email medikamentenkampagn  AT berlin.msf.org)

4 thoughts on “Whatever Happened to AIDS?”

  1. Thank you very much, ludek, for this excellent article. Your research is impeccable and your style is fantastic.
    Truly an amazingly eye-opening piece.

  2. Thanks for a great piece, Ludek. I agree that the celebrity approach to raising the issues of AIDS, poverty and suffering in the world tends to be very depoliticizing. The same could be said of the charity-themed approach to the UN’s Millennium Development Goals (MDGs) more broadly. Its proponents are well-intentioned, but the “do what you always do” approach is disturbing, and goes directly against encouraging citizens to pay more attention to structural injustices of current policies by their governments — and to get active in changing them. Thanks for stating this so well in your article.

    Sincerely,
    Rick Rowden
    Author, “Deadly Ideas of Neoliberalism: How the IMF has Underminded Public Health and the Fight Against AIDS”

    http://www.guardian.co.uk/global-development/poverty-matters/2010/nov/24/washington-consensus

    1. Thanks for your comment, Rick, much appreciated. Your book has been extremely valuable for my own research.
      And thanks for the link to your article. I couldn’t agree more – the myth of the demise of the WC is in need of serious debunking.
      Best,
      L.

      P.S. I just sent a longer reply to your gmail account.

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