The good fight

Global health advocates can come off as a pretty crabby bunch. When the United Nations released its annual report on the worldwide AIDS epidemic this week, the reaction was mostly a lot of sniping about rich countries’ slow response to the problem, or the political factors that prevent money from being spent appropriately, or anger that the U.S. government seems more interested in fighting the disease overseas than among African Americans at home. No doubt the complaints will be even louder this weekend in Mexico City, where the 17th International AIDS Conference opens Sunday. Amid all the sourness, it’s easy to lose sight of the fact that the news on AIDS is more good than bad.

The U.N. report is full of charts and graphs showing annual progress in areas such as the number of people dying of AIDS, living with HIV (the AIDS virus), or newly infected. There is a pattern to the curves on these graphs: For the most part, the numbers rise steeply in the 1990s, start slowing in 2000 and either head downward or level off in 2007. This is not coincidental. Near the end of the last millennium, leaders began focusing on solutions to some of the world’s most pernicious problems, and AIDS emerged as a top global priority. Since 1996, spending on the disease has increased nearly 40-fold, to $10 billion last year.

Progress might seem painfully slow to those who witness firsthand the toll taken by AIDS in sub-Saharan Africa or even some American cities, but it’s happening. The U.N. reports that worldwide deaths from AIDS dropped by 10% last year. The number of people on AIDS medication has jumped by 10 times in the last six years, and the number of new infections among children is falling, though the number of new infections overall remains constant.

Opponents of foreign aid bemoan the lack of evidence that the billions of dollars we send overseas do any good; apparently they haven’t been following developments in the AIDS community. Congress recently agreed to triple the amount the U.S. spends fighting AIDS and other deadly diseases to $48 billion over five years, money that will help stabilize poor countries, boost their economies and improve their relations with Washington. It’s smart policy, and it works.

AIDS advocates have a tough time acknowledging good news because they don’t want donor nations to get complacent. We’re nowhere close to a victory in the war on AIDS, and even with the uptick in spending, the world probably will fail to meet the U.N. goal of universal access to treatment by 2010. Donors and recipient countries are still doing plenty of things wrong, mostly because both find it difficult to reach out to the stigmatized communities most at risk. But they’re doing plenty right too, and for that they deserve more credit than they usually get.