Thirty years after Aids surfaced, Barack Obama is today expected to declare "the beginning of the end" of the disease thanks to the dramatic results achieved by antiretroviral drugs.
Underlining America's bipartisan response to the challenge, the US President will be joined on World Aids Day by two of his predecessors in insisting that the US will continue to lead the world in tackling the disease. Bill Clinton will participate by phone, while George W Bush will speak from Tanzania alongside the country's President, Jakaya Kikwete.
But fatally undermining the claim that the disease is on the way out is the decision by the Global Fund to Fight Aids, TB and Malaria to call off its latest funding round.
Countries around the world are slashing their aid budgets amid global financial strife. On Tuesday, George Osborne said the UK would "stick by its commitment to the poorest people in the world" by continuing to devote 0.7 per cent of gross national income to aid – but as this has fallen, that amounts to a cut of £1.164bn in the budget over the next three years.
Andrew Mitchell, the International Development Secretary, was challenged last night to ringfence help for HIV/Aids prevention work overseas after the Chancellor's decision to cut aid spending. Adrian Lovett, Europe director of the anti-poverty group One, said: "This must not result in life-saving HIV programmes being put at risk and Andrew Mitchell must ensure that they are protected."
The cancellation of the 11th annual round of funding means that fresh applications will not be accepted until 2014. It will also lead to dwindling stockpiles of the crucial drugs in many of the countries worst affected by the disease.
"There is a serious crisis," said Dr Tido von Schoen-Angerer, executive director of the Access campaign of Médecins Sans Frontières (MSF). "It's like a car going full speed that has suddenly run out of petrol. It is simply unacceptable that there is currently no plan to support countries for treatment scale-up until 2014."
The Global Fund, part public and part private, is the single largest donor for HIV funding, providing more than 70 per cent of the money for antiretroviral drugs in developing nations. The drugs, which first came into use in the 1990s, have transformed the prospects of those with HIV, giving them the hope of leading normal lives with tolerable side-effects for decades. Most of them will never fully develop Aids.
The impact of HIV/Aids has always been most devastating in sub-Saharan Africa. Years of work by the Global Fund in collaboration with agencies such as MSF have greatly reduced the incidence of HIV, but in South Africa an estimated 5.7 million people are living with the virus, and the number of new infections continues to outstrip the numbers being treated.
Despite Secretary of State Hillary Clinton's recent evocation of "an end to Aids in this generation", those countries now expect the numbers of sufferers dying to surge. In Zimbabwe, a recent study found that Aids-related deaths in Harare and Bulawayo had declined by 19 per cent after access to antiretroviral drugs was expanded, but now the country fears a reversal. Faizel Tezera, head of the local operation of MSF, told Reuters: "It is a disaster for Zimbabwe as a country. More than 86,000 people will be left without treatment and about 5,000 children will be affected."
In Malawi 70,000 new infections are expected next year, and because there will be no funding available for drugs, sufferers risk developing the full and untreatable version of the disease. "It is catastrophic for our nations, especially women and children," said Nokhwezi Haboyi, of the South African lobby group Treatment Action Campaign.
Aids first exploded into public consciousness in 1981, after being identified in a cluster of five gay men in Los Angeles. What rapidly became known in the popular media as the "gay plague" had jumped the species barrier from chimpanzees decades before. A massive international research effort led to the identification of the virus responsible.
Norman Fowler, Health Secretary under Margaret Thatcher, launched Britain's first, taboo-busting campaign "Don't die of ignorance", while through Europe and beyond the inhibitions connected with the name and function of the condom were blown apart.
Despite a massive research effort, no vaccine to immunise against HIV has yet been developed. Drugs such as AZT helped to impede the development of the disease, but had severe side-effects.
It was only with the launch of a new generation of antiretroviral drugs that people who had expected to die in their twenties and thirties found that they were now likely to live into their sixties.
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