In Durban

Sophie Cousins

The 21st International Aids Conference was in Durban last week. The last time it was held here, 16 years ago, Aids denialism in South Africa was rife, people were dying on the front lawns of hospitals, unable to access treatment, and President Thabo Mbeki had announced that Aids was caused not by a virus, but by poverty and poor nourishment.

A lot of progress has been made since then. Of the 37 million people living with HIV today, 17 million are on life-saving antiretroviral therapy. South Africa has the largest drug treatment programme in the world. Meanwhile, the number of people infected each year has stalled at just over two million, down from 3.1 million in 2000.

Born in the late 1980s, I first learned about Aids when Princess Diana made headlines in 1991 by shaking hands with an Aids patient without wearing gloves. Where we are now would have been unthinkable then. The optimism was contagious as delegates danced at the conference’s ‘No Pants No Problem’ party (that’s pants in the American sense) and spoke about ending the Aids epidemic by 2030.

Away from the main events, though, there was scepticism. People asked how we were going to end the epidemic in 15 years, when annual international funding fell from $8.6 billion to $7.5 billion between 2014 and 2015. US funding dropped by $500 million while funding from Britain, the second largest donor, fell by $135 million. The decline in funding could cause the epidemic to rebound and grow, especially in sub-Saharan Africa, where more than 70 per cent of people with HIV live.

‘What I’m seeing right now has scared me,’ the executive director of UNAIDS, Michel Sidibé, said, ‘if we continue to harbour the flattening and reduction of funding.’ Chris Breyer, the president of the International Aids Society, told me that ‘expanding treatment to the majority of people not on therapy is not going to happen with declining funding.’

There were calls for middle-income countries to take on more responsibility for funding their own responses, but this is easier said that done. Domestic spending made up more than half the total funding in 2015, but external donors are more likely than many domestic governments to fund programmes aimed at ‘key populations’, among whom more than a third of new infections occur: sex workers, injecting drug users, men who have sex with men, transgender people and prisoners.

The Global Fund to Fight Aids, Tuberculosis and Malaria will hold its fifth triennial ‘replenishment conference’ in September. The fund is asking for $13 billion to be spent over three years. The UK is yet to pledge, but the head of the fund, Mark Dybul, told me that, despite Brexit, he expected strong support from the British government.


  • 1 August 2016 at 10:02am
    Greencoat says:
    Why should the British government fund the health systems of foreign countries when many British people are faced with delays or restrictions in getting medical treatment?

    • 2 August 2016 at 9:20am
      John Lilburne says: @ Greencoat
      This is not about funding the healthcare systems of other countries, but about funding research into HIV and AIDS. Should we also stop UK funded research into malaria, antibiotic resistance, ebola or zika as this may be of primary benefit to the world rather than solely to our own citizens?

    • 2 August 2016 at 11:21am
      Greencoat says: @ John Lilburne
      Yes we should.

  • 3 August 2016 at 9:12am
    David Gordon says:
    I am sorry, but this is just nonsense.

    There are many reasons to pour scorn on Greencoat's response.

    First, the self-interest argument (presumably one he understands). Diseases such as malaria or Ebola may appear here or be imported. Global warming makes them more likely to become endemic here.

    Second, the generalisable nature of most biomedical research. Understanding of the mechanism of one disease will often lead to insights into the mechanisms of another.

    Third, UK biomedical research is amongst the best in the world. Being good at it is quite a good reason for doing it.

    Fourth, some of UK tropical medical research is obligatory. The major funder is the Wellcome Trust, and Henry Wellcome's will specifically mandates the Trust to do tropical medicine research.

    Fifth, and to me the most important, is the moral one. We have a duty to do our best to support research for better health for the world. Presumably this is the bit that Greencoat really can't understand.

  • 3 August 2016 at 10:55am
    Greencoat says:
    You're not sorry and it's not nonsense.

    We know how deadly diseases are being imported (or re-introduced) into the UK - and 'global warming' has nothing to with it.

    The British tax-payers' moral duty is to his fellow-citizens.

    • 3 August 2016 at 5:21pm
      David Gordon says: @ Greencoat
      I am indeed very sorry to see such a small-minded and petty comment on the LRB blog, and ignorant to boot.

      Global warming has a great deal to do with it. The South of England was malarious once before, and it would not need to be much warmer for the vectors of malaria and Zika to be able to live here. You ignore my second point, and the fourth point makes it clear that it is not all British tax-payers' money. Sir Henry Wellcome had a much better understanding than you of the moral issue.

    • 9 August 2016 at 8:06pm
      pgillott says: @ David Gordon
      There are concerns about climate change increasing the risk from some diseases, including dengue fever and the Zika virus, according to a recent Committee on Climate Change assessment; but not so much for malaria, said to be unlikely to be a transmittable disease in the UK in the next 60 years. It seems unclear how far temperature is a determinant: Oliver Rackham’s The History of the Countryside relates that malaria was present in the Fens from the sixteenth to the nineteenth century, a colder period than the present, and that its disappearance in the earlier twentieth is (or was, in 1986) unexplained.

      To be clear, I am not disagreeing with your overall point here – aid is and should be part of public spending, and to exclude research on diseases occurring elsewhere from that would surely be counterproductive.

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