The Lancet: HIV is a global disaster

HIV is a “global disaster” according to an editorial in the July 5^th edition of The Lancet.

The editorial was written to highlight the International Federation of the Red Cross and Red Crescent Societies (IFRC) World Disasters Report 2008. Unlike previous IFRC disaster reports, which focused on natural events, this year’s is concerned with the single issue of HIV.

Both the report and The Lancet editorial stand in marked contrast to recent suggestions that the scale and impact of the global HIV epidemic has been exaggerated and that HIV has received an unjustified proportion of world health resources.

There are three central messages in the IFRC report:

• Efforts to tackle HIV are not being aimed at the correct groups. The report highlights how many countries with HIV epidemics located in high-risk groups (such as men who have sex with men, sex workers and injecting drug users) have failed to devote resources to preventing the transmission of HIV in this groups. Rather they have opted for more general prevention messages, often delivered through schools.
• Money provided by donor organisations is not going where it is needed most. Bureaucracy, a lack of coordination, and ear-marking mean that funds are not reaching the communities which need them most, says the report.
• Groups with a high risk of HIV – such as men who have sex with men, sex workers and injecting drug users – are often highly stigmatised and experience discrimination. HIV prevention is being hamstrung by the criminalisation of these groups, which the report also says have little access to prevention or treatment services.

HIV’s many consequences mean that it is a long-term and complex disaster, the IFRC report suggests. For example in southern Africa, HIV has had what The Lancet calls a “catastrophic effect on the population, health systems, economy and social stability.”

Countries with generalised HIV epidemics are facing “disaster” because of HIV, says the report. Furthermore, in countries with more focused epidemics, HIV has devastating effects for the marginalised groups which the virus most affects.

“The IFRC is right to raise these points”, says The Lancet Editorial, “25 years after the start of the epidemic, governments should focus HIV/AIDS programmes on those most in need, donors should ensure their aid is effective, and public-policy decisions should be based on evidence rather than moral judgments.”

Humanitarian organisations need to increase both the scale and scope of their HIV efforts, the IFRC says. “We agree” write the authors of The Lancet Editorial, “the HIV/AIDS epidemic deserves the increased attention of the humanitarian community.”