The HIV/AIDS wars in Vienna

Whether activists and politicians want to admit it, there is a heated fight going on at and surrounding the International AIDS Conference going on in Vienna.

The debate is one that I wrote about a few weeks back: over spending on life-saving anti-retroviral treatments for AIDS patients in the developing world. More than half of those receiving treatment today are funded by the U.S. government. But those numbers won’t keep edging up as fast as expected. And activists — including Archbishop Desmond Tutu of South Africa in the New York Times today — are accusing the U.S. government of walking away from a crisis. The Obama administration is also fighting back. An op-ed by Ezekiel J. Emanuel, an advisor to the president in the Office of Management in Budget, counters in the Huffington Post.

Both sides are right. But to be honest, I think they are also both asking the wrong questions. And the one I keep asking myself is this: Are fights like this really helpful? This fight seems to have paralyzed all other discussion, pushing debates about prevention, about coinciding diseases like tuberculosis, even about mother-to-child transmission, to the background — at least to the back of what the public is hearing from the conference. If there’s concern about dollars spent, the Obama administration is pledging a whopping $63 billion in new global health spending. Why not focus on how great that could be for HIV/AIDS patients — if people cooperate and get on board?

I guess this is an inevitable outcome of the scarcity of money and plethora of demands in the world — we have to fight for priorities. And I’m saying that sometimes a fight isn’t a good thing; that’s how HIV/AIDS got on the policy agenda in the first place, and it’s been a long, uphill battle.

But in this case, everyone actually agrees on the importance of HIV/AIDS. They just don’t agree how to do it. Attacks against the other side’s committment to the cause aren’t helpful; better to sit down and learn from one another. Sounds like a kumbaya moment, I know, but I still don’t think it’s such a bad idea. It’s distressing to think that something that should be as uniting as stopping HIV/AIDS has pitted so many well-intentioned people against one another. (These fights happen with alarming frequency in the world of development aid, though it’s rare we see it so publicly.)

So a plea from an outsider: Remember what you’re fighting against. (Hint: it’s not each other.)