The Failure of HIV/AIDS Prevention and Strategies

According to the most recent data released by UNAIDS, 36.9 million people globally were living with HIV in 2014, with 70 % of them living in sub-Saharan Africa. Two million new infections were registered in 2014 with 70 % of them in Sub-Saharan Africa. As of 2013, AIDS has killed more than 36 million people worldwide (1981-2012). In 2014 1.2 million people died from aids related causes with sub-Saharan Africa making up 65 % of deaths. UNAIDS has been directed by an African since 2009. This gave new hope to Africans. But although the global mortality has decreased from 2 million in 2005, we are still faced with an unacceptable situation affecting particularly the African continent, because the international organizations combating HIV/AIDS continue to ignore the particular socio-cultural characteristics of the continent, where being HIV positive is still something to hide, even to your family and close friends.

Since 1988 the world has observed World Aids Day on December 1st. On these occasions reference is often made to the failures of the international community to bring Aids to a halt – especially in Sub-Sahara Africa. This year’s campaign theme is ‘On the fast track to ending Aids’. Yes, there is certainly a need to speed up, but more so with new strategies, as will be argued in this article.

The emphasis on a curative approach rather than on preventive measures aiming at modifying behaviors of contaminating individuals at the community level has played well into the hands of the pharmaceutical industry. For more than twenty years pharmaceutical companies blocked access to lifesaving drugs for millions of people, especially in Africa, because they were afraid that allowing Africans to import generics drugs would set a precedent that would ultimately diminish their own profits. As long as the 20 year patent was effective, a full battery of life saving drugs could easily cost 15.000 $ – a price well beyond the affordability of most patients in low and middle income countries. Why bother to know your HIV status, if the drugs to save you were non affordable anyway!

UNAIDS continue to address HIV/AIDS with generic packages dictated on basis of so-called human rights programming. This has most certainly contributed to the death of a staggering number of about 40 million people since the early 1980’ies. Most of these people, often innocent mothers and children have died because of the message to governments and health organizations: A HIV positive person has the right to keep his status a secret even to his spouse.

The Right of the Community to Know

Policies and practices in terms of combating the AIDS pandemic assume that aids is an individual and private matter. By having placed the AIDS discussion in the context of human rights, it has become virtually impossible to question the principles guiding HIV/AIDS projects combating HIV/AIDS. It seems to be assumed that once an individual realizes and understands the implications of his/her behavior then an appropriate responsible response will be adopted. However, sexual behavior is seldom based on reason alone, if at all. It is obvious that what by HIV/AIDS project planners is considered a private concern, has many and serious public consequences in cultures where procreation and community are more important for the individual identity than concerns about HIV/Aids risks.

Obviously, the current practice of defending confidentiality and privacy with regard to testing only makes it more difficult to even cut through the stigma of HIV/AIDS. These sentiments continue to prevail in most African countries. We are still far from that situation, which met me on accompanying the late First Lady of Gabon at a meeting in Geneva for African First Ladies, when an American employee introduced himself with ‘Hi, I am Bill. I am HIV positive’.

Human Rights and Social Inequality

The Human Rights Declaration states that ‘The family is the natural and fundamental group unit of society and is entitled to protection by society and the State’ (article 16 (3)). Article 29 of the Declaration states further that ‘In the exercise of his rights and freedoms, everyone shall be subject only to such limitations as are determined by law solely for the purpose of securing due recognition and respect for the rights and freedoms of others and of meeting the just requirements of morality, public order and the general welfare in a democratic society’. In relation to HIV/AIDS, the question would be whether limiting an individual’s freedom by depriving him of his right to confidentiality and by enforcing HIV screening would violate Article 29. The response lays in the balance between the individual’s freedom and other human rights principles, such as for example the principle that an intervention should serve the “best interest of the child”, which continues to be the guiding principle for UNICEF. It may be important to note that back in 1948, when the Human Rights Declaration was adopted there were no representatives from the African continent in the group of persons preparing the declaration.

The universal declaration on human rights is closely associated with the concept of democracy. African Governments and for that matter countries throughout the world, except for one, have been careful not to take a firm stand against the spread of Aids to avoid falling into the group of non-democratic states. This has prevented HIV/AIDS from being treated as an epidemic. Rather it continues to be considered as an individual disease. As an epidemic, HIV/AIDS has far reaching consequences and would have met with regulations as those which were introduced to protect humanity against the bird flue (H5N1), which from its inception until 2007 had (only) claimed 216 lives out of 349 cases. With Michel Sidibé, a Malian, at the helms of UNAIDS since 2009, this UN organization has become the strongest advocate of a so-called human rights approach to the detriment of the lives of millions of innocent people. Civil societies became natural partners rather than governments.

Where Human Rights are Defined in the Interest of Family and Nation

Cuba is the only country in the world which has had the courage to legalize in favor of compulsory HIV testing. The current UNICEF Executive Director, Anthony Lake, had obvious difficulties classifying Cuba as a rogue state, when he as National Security Adviser to President Clinton prepared a list of countries deserving this epithet. When Cuba had a population of 12.5 million people in Cuba, it was estimated that there were less than 5000 people living with HIV. To put the achievements of Cuba into perspective, it serves well to compare it Jamaica’s population of about 2.5 million people with 40.000 HIV positive people. Jamaica made consistent efforts to implement the guidelines for combating HIV/Aids as prescribed by the international community.

Extrapolating from the Cuban and Jamaican data and assuming their validity, a simple arithmetic calculation suggest that if the Jamaican government had implemented compulsory HIV screening, it could have had less than one thousand HIV carriers. Instead of 40 million persons having died from Aids related causes since its outbreak, we might instead have had around one million persons having died from Aids. Instead, the UN institutions led by WHO and UNAIDS, followed closely by UNICEF, UNFPA and UNDP dictated the medical profession to maintain confidentiality regarding HIV positive carriers to the detriment of family, the community and the nation.

Towards an AIDS Free World

Just as UNAIDS has a professional and moral responsibility to give priority to policies and interventions serving the best interest of the family and the community, similarly governments have a responsibility to protect communities and the very state itself from the adverse impacts of HIV/AIDS on economic and social development. The UN must support African Governments to be courageous enough to consider human rights from the perspective of the family and the community, and implement HIV/AIDS intervention strategies accordingly. Today, when women account for more than half the total number of people living with HIV in sub-Saharan Africa and HIV/Aids is the most frequent cause of death among young people under twenty, it is hypocritical to take a narrow view of democracy and human rights, equalizing them with individual freedom of choice, only because it may serve market interests.