It has been more than 30 years and an estimated 36 million deaths world-wide since the beginning of the HIV/AIDS crisis, but new research from international health experts suggests the pandemic is now roughly 25 per cent smaller than originally thought. However, Canadian diplomat and former UN special envoy for HIV/AIDS in Africa Stephen Lewis says now is no time to celebrate victory over the virus.
"I don't think the response has been a success at all, although it is labeled as such," says Lewis, who was in Vancouver on September 17 to speak on the state of the HIV/AIDS pandemic at the Wall Exchange downtown public lecture series hosted by the Peter Wall Institute at UBC.
The Global Burden of Disease Study, which debuted its findings in July 2014 at the International AIDS Conference in Melbourne, indicated that the number of people currently living with HIV/AIDS is closer to 29 million, compared to a current UNAIDS figure of 35 million.
"There has been some private behind the scenes dispute between the two over [the figures]... but I think the numbers are so large regardless that we should dwell on what's actually happening," Lewis says.
Still, the study notes that the brunt of the pandemic is shouldered by sub-Saharan Africa, where access to treatment isn't universal, gender inequality is prolific and millions of children have been orphaned by the disease.
According Lewis, there is no question the world has come a long way from the "carnage" of the disease ten years ago, with an estimated 13 to14 million people are now able to access treatment, but stresses that there is a huge amount of work left to be done.
"To suggest that the epidemic is over because you're getting people into treatment is to forget the social and psychological and economic consequences go on for generations – it isn't easy to measure them," he explains, noting that more than 17 million children have been orphaned by the virus globally.
"I'm not impressed, as others are, with the progress that has been made because it has been achingly slow. We have lost millions of people whom we shouldn't have lost."
Lewis criticizes the international community and some UN agencies for the sluggish response to the crisis that resulted in so many unnecessary deaths. He says the same kind of response is helping to fuel the current Ebola crisis in West Africa, which the World Health Organization now estimates will infect thousands more before the disease is contained.
Women and the pandemic
Lewis sees more parallels between the spread of Ebola and the progression of HIV/AIDS on the African continent. In both cases the disease strikes more women than men, with recent reports suggesting as many as 75 per cent of Liberian victims of Ebola are women.
Experts suggest social inequality is largely to blame. As Ebola spreads throughout West Africa, women remain the primary caregivers for the ill and are more likely to become infected by their family members instead of bringing them to doctors and nurses at treatment centers.
In the case of HIV/AIDS, Lewis notes that many women in Africa still live in a culture where they do not have the power to say no to sex or insist on using a condom.
"The nature of gender inequality is so entrenched... that women ultimately suffer. They become the most vulnerable," says Lewis, noting that combatting sexual violence and its staggeringly high HIV transmission rates are only now being focused on.
"In many many parts of the African continent, easily between 60 and 70 per cent of those who are infected are women," says Lewis, calling these transmission rates "terrifying."
"We don't have the same energy, we don't have the same urgency, we don't have the same compelling determination to overcome it where women are concerned."
Stigma and discrimination against those carrying the disease, particularly women, has also made it difficult to get those affected into treatment. Recently, Uganda's president signed into law a new bill that criminalizes the transmission of HIV and singles out women by requiring survivors of sexual assault and pregnant women undergo HIV testing. Such provisions increase discrimination and stigma associated with the disease, and distrust of the health care system may discourage women from seeking care.
The danger of donor apathy
Given many of these factors, Lewis cautions that although progress has been made in our ability to treat HIV/AIDS, donor nations must not be complacent.
"We're still not getting from the wealthy countries in the world the kind of financial response to support the rolling out of treatment," says Lewis, noting that the Global Fund to fight AIDS, Tuberculosis and Malaria was several billion dollars short of its goals at the last replenishment meeting.
"Now should be the time to ring the alarm bells," he says.
According to Lewis, public relations decisions by UN agencies to emphasize slogans like "The End of AIDS" or "An AIDS Free Generation" are supporting a general notion that the pandemic is almost over.
"They have almost induced in the donor nations a sense of complacency."
"There's no question that [complacency] has become pervasive – that it is now much more difficult to get concern for HIV into news stories. It's more difficult to extract funds from donor countries," he says.
Some of the countries with the highest rates of the disease are already reeling from the consequences of evaporating support. Lewis says that in countries like South Africa, which has the highest number of people living with the virus at estimated 6 million individuals, are having to scramble to find hundreds of millions of dollars for treatment programs, on top of already funding a huge part of the response.
What's more, Lewis says there is a general lack of appreciation in the Western world as to just how capable communities across Africa are, when given the right supports.
"You understand as you move through Africa – and this was brought home vividly to me when I was the envoy – that the sophistication of the communities, particularly women at the grassroots, is extraordinary," he says.
"The inability of the rich world to understand the knowledge, the generosity of spirit, the expertise, the tremendous community networks that exist... it's a great failing of the Western world."
Stephen Lewis is the board chair of the Stephen Lewis Foundation, which is dedicated to turning the tide of HIV/AIDS in Africa, and is co-founder and co-director of AIDS-Free World. You can watch his Wall Exchange lecture on YouTube, and read about Twitter highlights from his talk on Storify.