World AIDS Day, celebrated on 1 December, is an opportunity to reflect on the fact that 2005 shows the highest level of infection ever, rising many times faster than treatment, writes Philip Stevens* Each year, the HIV/AIDS advocacy industry uses World AIDS Day on 1 December to rehearse familiar themes, while the number of victims rises steadily. This year the tagline is "Stop AIDS. Keep the promise", an exhortation for yet more aid money. The idea that AIDS in Africa and other poor countries can only be reversed with large sums of aid money is certainly politically attractive. After all, only someone with a complete disregard for humanity could argue against it. But this tin-rattling is not providing sustainable answers to the AIDS problem. Instead, this year's World AIDS Day should be looking at some more effective approaches. First, we must examine exactly what World AIDS day is asking us to support. Top of the list is further funding for the World Health Organisation's flagship "Three by Five" programme, which had initially hoped to get three million people onto life-prolonging ARV treatment by the end of this year. With one month to go, this target will be missed spectacularly. The "Three by Five" programme is an example of a top-down programme that has failed because its strategy was hijacked by the AIDS activist lobby. This lobby has for years chanted "treatment for all". But dilapidated African health systems are simply unable to distribute the medicines to all those in need, let alone monitor treatment. A more considered strategy would have recognised this and emphasised prevention. As a result, the total number of people living with AIDS has actually increased since the programme started. Year 2005 saw the highest number of new infections since records began. It is time to tackle the real reasons AIDS is flourishing in many parts of the world. AIDS is so tenacious not because of the cost of medicines or a lack of aid. The reason AIDS has taken such a hold in Africa and parts of Asia is because these regions suffer from stifling political and economic oppression. Leading public health experts are unanimous that prevention is of paramount importance to combat AIDS. But political oppression has made it difficult to spread that message. Until recently, President Mbeki refused to acknowledge that South Africa even had an AIDS problem, a factor that contributed to the advance of the disease in that country. By contrast, the government of Thailand early acknowledged AIDS as a problem and encouraged discussion and education, bringing infection rates down rapidly. Yet recently the Thai government has oppressed intravenous drug-users; police killed more than 2,000 in 2003 and thousands more were imprisoned. The consequence: drug use was driven further underground and open discussion of the need to use sterile needles was made impossible. As a result, HIV infection rates are now soaring among drug-users. Economic oppression is an even more fundamental vector of this disease. When governments restrict the ability of people to start up businesses and exchange goods freely under the rule of law, poverty and hopelessness are guaranteed. People flee from the countryside looking for work, to be greeted with urban slums and unemployment. Rent controls, oppressive planning restrictions and lack of land title mean there is a woeful undersupply of suitable housing. It is also impossible for people to use their houses as security against loans. Poverty leads desperate parents to sell their children into the sex trade. For poor women with few employment opportunities, prostitution is one of the few options available. Drug abuse is rife. In the poverty of the favelas in Brazil and the shanty towns of Africa and India, HIV finds fertile ground. But this urban squalor need not exist if people had real employment opportunities and the ability to create wealth for themselves. Unfortunately, governments that restrict economic liberty make this impossible. At the moment, the West is coming up with the wrong answers about AIDS. Giving more financial aid might please Irish rock musicians, but in reality it is sustaining corrupt politicians and preventing Africa from helping itself. Money for AIDS projects can make things worse: the Global Fund had to suspend grants to Uganda in August after uncovering evidence of systematic embezzlement. In Ghana, hundreds of spurious NGOs have sprung into existence with the sole purpose of obtaining Global Fund money. Instead of salving its conscience by throwing aid money at the problem, the West could do something of far greater value by undermining the ability of political cliques to oppress their people politically and economically. Western governments should therefore be encouraging countries to institute property rights and foster respect for the rule of law. This is the only way the benefits of economic growth will reach the poor and allow them to escape the squalid conditions which spread AIDS. The AIDS lobby for too long has been giving us the wrong answers to the wrong questions. Freedom has brought prosperity to the West and ensured it has remained insulated from the worst of the AIDS crisis. Let's hear more voices in 2006 calling for this freedom to be extended to where it is most desperately needed. * The writer is director of the Campaign for Fighting Diseases, an international development think-tank in London.
