Washington Post, December 1, 2004
EDITORIAL: A Female
THIS YEAR an estimated 3.1 million people have
died of AIDS, or roughly 8,500 people daily.
An additional 4.9 million have been newly infected
with the virus, with the result that more people
live with HIV than live in California. The
global response to the pandemic is more vigorous
than it's ever been. And yet the policy mood
among AIDS groups risks undermining progress.
The good news is that, in the past three years,
global funding for the battle against AIDS
has jumped from $2.1 billion to $6.1 billion.
As UNAIDS reports in its latest survey of the
pandemic, the number of secondary-school students
receiving AIDS education has nearly tripled,
the number of visitors to voluntary counseling
and testing services has doubled, and the number
of people receiving antiretroviral therapy
is up 56 percent.
The bad news is that the pandemic's momentum
still outstrips these efforts. Although counseling
and testing are more widely available, less
than 1 percent of adults ages 15 to 49 use
these services. Fewer than one in 10 pregnant
women are offered services that prevent HIV
transmission during pregnancy and childbirth.
Only one in 10 people who need antiretroviral
therapy are getting it.
No technological silver bullet will be available
soon. Researchers believe it will be a decade
or more before there is an AIDS vaccine, and
a microbicide -- a vaginal gel or foam that
would protect women from partners who refuse
to use condoms -- may be five years away. In
the meantime, the world needs to redouble its
commitment to provide resources for prevention
messages, antiretroviral treatment and care
for orphans. In its recent omnibus appropriations
bill, Congress provided $2.9 billion for AIDS,
nearly half the global total; France, Sweden
and Holland have also been generous. But in
the past fiscal year, Germany, Japan, South
Korea and Saudi Arabia gave much less than
their fair share, as measured by the size of
their economies, to the Global Fund for AIDS,
Tuberculosis and Malaria.
Even with more generosity, resources will always
be limited. This is why the latest policy direction
in the AIDS community is disturbing. Led by
UNAIDS, donors are increasingly focused on
women's particular vulnerability to HIV. In
many poor societies, teenage brides are married
off to older men who promptly infect them:
Surveys in African cities find that HIV infection
rates are higher among married females between
the ages of 15 and 19 than among sexually active
singles of the same age. Because of these horrifying
data, AIDS groups are right to point out that
the Bush administration's "ABC strategy"
(Abstain, Be faithful, use Condoms) has limits.
Most vulnerable teenage brides are faithful,
but they cannot abstain or negotiate condoms,
particularly since they want or are expected
to have children.
Even so, the new emphasis on women may turn out
to be an error. In a world of scarce resources,
it makes sense to focus prevention efforts
on high-risk groups: men who have sex with
men, drug users, sex workers, truck drivers.
It's not just that these groups are most at
risk of infection; it's that they often do
the most to spread it. A sex worker, for instance,
can infect hundreds of people in the course
of a month; targeting a prevention message
at that worker is vastly more effective than
targeting it at a faithful teenage bride, however
awful her predicament. A central problem in
AIDS prevention strategies is that high-risk
groups are stigmatized, and hence often ignored;
there's a great reluctance to put scarce money
where it's most likely to be effective. By
focusing its latest report on "Women and
AIDS," UNAIDS is doing nothing to combat
<< Washington Post -- 12/1/04 >>
to a friend
Us Newsletters News