Earlier this month the UK announced that it will stop giving direct financial aid to India by 2015 reflecting the country’s “economic progress and status as a global force.”
But when it comes to health, favouring development assistance for countries based on income will be disastrous for the HIV epidemic as our new report published this week ahead of World AIDS Day demonstrates.
HIV rates of infection are increasing in vulnerable and politically isolated groups such as sex workers, men who have sex with men, the transgender community and people who inject drugs. UNAIDS data published last week shows that since 2001, the number of people newly infected in the Middle East and North Africa increased by more than 35% and that there has been a substantial increase in new HIV infections in Eastern Europe and Central Asia in recent years where drug-related transmission is driving the epidemic.
It can be no coincidence that such regions are largely middle income areas where overseas aid is being withdrawn or significantly reduced. As Don’t Stop Now: Calling For A UK Blueprint To Achieve An HIV-Free Generation indicates, the majority of people living with HIV are now in middle income countries - 19 million compared to the 12 million in low income countries. In India alone, there are 2.4 million people living with HIV, making it the country with the third highest HIV burden.
Clearly there are critical health needs in both low and middle income countries, but HIV and other public health problems do not discriminate based on where people live and aid decisions need to address the greatest need and target the most marginalised and excluded if we are really to break the back of global poverty. Middle income countries have far lower rates of antiretroviral coverage for people living with HIV than low income ones for example as well as much higher rates of multi-drug resistant tuberculosis.
What or how a government decides to spend its money on has always been deeply political. When faced with an inadequate funding pot most will be reluctant to spend resources on health services for politically unpopular groups that won’t win them any votes. If international donors also start to disengage then there is a very real danger that we will see an alarming roll back on achievements made to date in the HIV response.
In May, before the G8 summit at Camp David, David Cameron pledged to champion the need to “make sure our aid reaches those that need it most.” Since then he has spoken often of the need for “a golden thread of development”. Tackling HIV is a crucial strand of that thread as it influences other critical drivers of global poverty including gender issues, human rights and accountability.
The UK and other international donors have an essential role to play in constructing a ‘golden thread’ of economic, social and political assistance to support the majority of people living with HIV regardless of where they are based. Leadership in this arena could help avert 12.2 million more new HIV infections and prevent 7.4 million more AIDS-related deaths between now and 2020 in line with the Investment Framework for HIV/AIDS which maps out the most cost-effective and results-driven model for HIV investment and programming.
Next year, the UK has the chance to reclaim its high level political leadership relating to one of the greatest health challenges of our generation. As both host of the next G8 summit and co-chair of the post-Millennium Development Goal process, Cameron is poised to exert global influence that would save millions of lives. What we need now to help with that process is a blueprint mapping out the UK’s strategy on HIV that will lead us to the tipping point that would be the beginning of the end of AIDS, a blueprint that embraces rather than punishes the poorest and most marginalised.
The International HIV/AIDS Alliance works to support communities to address HIV prevention, treatment and care to most effectively reduce the spread and impact of HIV and AIDS around the world.