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Greater urgency and better health care systems needed to fight HIV/AIDS

I attended the International AIDS Conference in Durban, South Africa, in July this year, as part of the global ACTION partnership contingent. International HIV/AIDS activist Charlize Theron caught my attention with her comments at the opening ceremony. “I am sad to be here at the 21st International AIDS Conference,” she said. “This is the second time my home country of South Africa has hosted…We shouldn’t have had to host this conference again.”

The conference was, in part, an opportunity to highlight the impressive progress in the fight against HIV/AIDS:  new HIV infections have fallen by 35 percent since 2000, nearly 19 million people living with HIV are receiving antiretroviral therapy (ART), and 8 million lives have been saved. Yet, we are not where we need to be. I, like Ms. Theron, find progress on HIV/AIDS is painfully slow.

Ms. Theron attributed the failure to combat HIV/AIDS more aggressively to lack of concern for the marginalization of the communities most affected. In other words, discrimination:  “The real reason we haven’t beaten the epidemic boils down to one simple fact:  we value some lives more than others. We value men more than women. Straight love more than gay love. White skin more than black skin. The rich more than the poor. Adults more than adolescents.”

Hardly anyone would disagree that HIV/AIDS affects more women than men, more gay people than straight, more blacks than whites, and more poor people than rich. But that’s only one side — the easier side — of the story.

The photo above depicts a wrenching scene at public hospital in north-eastern Uganda, my home country, in 2015. Photo by Olandason Wanyama for the Daily Monitor.

While at the conference, I received a call from my family in Uganda informing me of the death a childhood friend and neighbor. He died from AIDS. Two months later, in September, I received another call informing me of yet another death — my cousin — also from AIDS. Both men were in their mid-30s and married with children. Just before their deaths, my immediate family spent hundreds of dollars trying to properly diagnose and treat our mother, who had been unwell for over a year, but there were no doctors to provide a diagnosis. Last month, she was rushed to an international hospital in a coma. Back in 2008, when my father showed advanced symptoms of prostate cancer, it took two years, countless hospital visits, and thousands of dollars spent on a corrupt system (buttressed and propelled by the severe shortage of qualified physicians) before we could find treatment for him. This kind of crisis is not unique to us.

The collective failure to effectively combat HIV/AIDS goes beyond discrimination. At the heart of Africa’s failure is a story of broken health care systems:  facilities with no doctors, no equipment, and no medical supplies to provide even the most basic diagnoses in a timely way to ensure the best outcome. It is story of under-investment in health care because of budget constraints and mismanagement.

This side of the story doesn’t discriminate between gender, age, sexual orientation, or skin color — even wealth is no guarantee for receiving quality care. In such conditions, no life is more valued over another. It is this failure to develop truly modern and sustainable health care systems capable of protecting life, and it is frustrating many activists like me. How long must people wait for a course correction, and at what cost?

Over the last 15 years, the international community has shown amazing commitment to saving lives and fighting infectious disease in some of the poorest countries in the world. The response to the Ebola crisis is a perfect example. The swift international response helped halt the spread of the disease in West Africa, saving thousands of lives and averting an even worse crisis.

However, that swift response has not translated into a sustainable improvement in public health systems. As Paul Farmer (professor of global health at Harvard and co-founder of Partners in Health) pointed out in 2014, there were fewer than 50 doctors working in Liberia’s public health system when the Ebola epidemic hit the poor country of four million people. In fact, the African region as whole has only 2.7 physicians for every 10,000 people — 87 percent fewer than the Americas.  Shame on all of us for allowing, and in some ways aiding, such disparities to continue to exist in today’s world.

This World AIDS Day, let us pledge to focus more on creating health systems and infrastructure so that when it comes to global health, we go beyond just responding when pandemics occur to actually preventing them in the first place.