Pulling It Together: Bono, Jon Stewart and the HIV/AIDS Message
One of the most interesting conversations on a health topic happened recently on The Daily Show between Bono and Jon Stewart. Bono told Stewart that we were “at the beginning of the end of the AIDS epidemic,” promising an announcement the next day that would explain how a combination of early treatment, treatment for pregnant women, and circumcision, would turn the epidemic around if the American people would continue to put money into the cause. Stewart responded cautiously: “I am looking forward to hearing that,” he said, “because that sounds remarkable and people’s hopes have been raised before about the end of this disease, but I really hope that there is something.”
The conversation between the two captures the tension between the opportunity for new optimism and the continuing need for realism about the AIDS epidemic. How do we strike the right balance between these two messages? Are there other essential messages?
Bono is right that research now shows the potentially transformative impact of early treatment. Studies now show that HIV, if treated early, need not progress to AIDS any longer. Just as important, the chances of people with HIV passing on the virus to uninfected partners is reduced by 96% if they are treated early. As a result, modeling shows that the combination of early treatment and other measures such as circumcision can have a huge impact on the global epidemic if they are implemented together and with adequate funding. It was certainly appropriate for Bono to choose World AIDS Day to spotlight the remarkable progress that has been made. And the message of new hope focused renewed attention on HIV, including by President Obama.
But, Jon Stewart’s note of caution is as appropriate as Bono’s enthusiasm. Marshaling new resources on the scale needed to achieve the kind of impact Bono is touting will be a challenge, especially in today’s global economic and budgetary environment. There were 6.6 million people in treatment in low- and middle-income countries in 2010, up from half a million in 2001 and up 1.5 million just since 2009. That is a great achievement. And treatment services are being delivered more efficiently than ever before. But an estimated 34 million people are living with HIV, and less than half the 14.2 million estimated to be eligible for treatment under current guidelines currently receive it. Although infection rates have been declining, there were still 2.7 million new infections last year. As a result of the sputtering worldwide economy, nations are struggling to keep up even current levels of funding, let alone increase them dramatically. In fact, The Global Fund for HIV, TB and Malaria recently announced that it has had to suspend its next round of new grants. There are scientific and implementation challenges as well, as Jon Cohen chronicled in his outstanding review of the new research on early treatment in Science.
In her recent address on HIV, Secretary Clinton struck the right balance, calling for an AIDS- (not HIV) free generation as a goal, but noting that we still had a long way to go. And the President reminded everyone that the epidemic in our own country is stuck in neutral. Speaking on World AIDS Day he said: “…The fight is not over — not by a long shot. The rate of new infections may be going down elsewhere, but it’s not going down here in America.” It is important to be both hopeful and realistic because while we can aspire to fulfill the promise of recent scientific advances, over-promising could backfire with the public when nations do not put up new resources and hoped for results are not there.
Our polling over many years shows clearly that the main variable in public support for funding for HIV/AIDS (and global health more broadly) is whether or not the public believes funding will make a difference. Now new research about the effectiveness of testing and early treatment allows the case to be made much more strongly than ever before. Taxpayer dollars have saved millions of lives and have not been wasted. New money for HIV/AIDS will make a difference and save many more lives. When it comes to marshaling critical support for funding that is the most important message the public needs to hear.