How ironic that, with the theme “Take the Lead” for this year’s World AIDS Day, the world is presented with newly revised and lowered estimates of AIDS prevalence around the world. This “correction” comes from UNAIDS, the Joint UN Program on HIV/AIDS which oversees or coordinates ten co-sponsors (UNHCR, UNDP, UNICEF, WFP, UNFPA, UNODC, ILO, UNESCO, WHO and the World Bank), a pantheon of global leadership indeed. And yet it has taken years of clamoring and criticism — by everyone from academic epidemiologists to African activists — to push UNAIDS to rework its estimates of this devastating pandemic. Not a very good example of leadership in action.
The lowered estimates are mainly the result of “refined” statistical methods. While previous estimates were based largely on surveys at urban prenatal clinics (whose rates were then extrapolated to whole countries), house-to-house and other surveys showed the prevalence to be about 80% of what had been estimated.
As Stephen Lewis points out, it is hard to know what people will make of these numbers. Perhaps some will see them as an opportunity to feel hope that there is progress. Others may see them as confirmation that the HIV establishment doesn’t know what it is doing. Most dangerously, however, some donors and governments might relax a little, somehow believing that there is less to do — which can hardly be farther than the truth.
Closer to the ground, we can see what real leadership on HIV and AIDS looks like:
• The people living with HIV who publicly disclose their status, especially those who were earliest to disclose in their communities, where they risked their lives to do so.
• The thousands of health workers and community organizers who have dedicated themselves to providing care for communities overwhelmed with HIV, and have strategized brilliantly to mobilize and manage scarce resources to have the greatest impact.
• The children who, having lost parents, step capably and uncomplaining into the role of raising younger children in their care.
• The determination and rage of groups like Act Up, which have forced the development and greater accessibility of ARV medicines.
• The solidarity represented by organizations like Partners In Health and Medecins Sans Frontieres, committed to providing first world health care and pharmaceuticals to poor communities around the world.
This is leadership in action.
Those agencies and individuals in control of the world’s vast streams of wealth, whose small spigots are so inadequately turned on over the giant basins of HIV need, may wear the mantle of world “leadership,” but many don’t deserve it. If the elite and powerful had anywhere near the courage, dedication, intelligence, and passion of the people directly confronting HIV in the world today, things would be different. We could restore health care systems, relieve poverty, extend public water and sanitation projects, improve nutrition, and widely distribute affordable second-line medicines. We could also generate hope, little nurtured by the timid and bureaucratic half-measures deemed realistic by the “leaders.”
If the AIDS Day slogan “Take the Lead” is to have any real meaning, we have to find ways to empower and recognize leaders who treat health as if people matter — especially people with HIV.