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“We Must Keep Going”: Lord Fowler on the Global Fight Against AIDS

This article will soon be published in Chamber’s quarterly journal alongside exclusive op-eds from the Prime Minister Rishi Sunak and the Shadow Secretary of State for Levelling Up, Lisa Nandy. To receive your free, digital copy, register for the Chamber newsletter here.

34 years on since the first World AIDS Day, its meaning in the UK is now somewhat different. Certainly, there is a lot of progress that still needs to be made, however, transmission has been driven down and those diagnosed can now, with the available treatments, live full and healthy lives.

However, this is, and always has been, a global issue and the tale is very different in many parts of the world. In 2021, there were 650,000 AIDS-related deaths worldwide, with the vast majority concentrated in low- and middle-income countries. In this context, global, collaborative action between nations is essential.

Against this backdrop, Policy and Research Analyst for Curia’s LGBT+ Commission recently met with Lord Fowler, former Health Secretary and Lord Speaker, to discuss the UK’s contribution to the Global Fund and his reflection on the 34th World AIDS Day.

Not-so-global Britain?

Appropriately, we sat down with Lord Fowler on the day that it was announced that the UK would be scaling back its contribution to the Global Fund over the next three years—from £1.4 billion to £1 billion. Given the importance of the Fund in tackling HIV and AIDS across the world, this announcement came to the dismay of those working in the sector.

On the dip in funding, Lord Fowler noted that, despite the global economic challenges facing all countries, the UK was something of an outlier: “The fact of the matter is that there are very few countries who are reducing their figure of aid rather than increasing it…it’s sad that Britain, which has done so much to lead the movement to combat AIDS, should be at the rear of the line at the moment.”

While these conversations tend to exist in the abstract, around the strengthening of health systems and increased access to care, Lord Fowler drove home the human cost of this decision very frankly: “It simply means there are going to be fewer people treated, the development and delivery of medicine is going to be put back and it’s going to mean deaths which can be prevented. It’s as stark as that really.”

Moreover, these extra, preventable deaths disproportionately affect the young, often, the very young. In 2021, a staggering 98,000 children (younger than 15 years old) died from HIV-related causes.

AIDS: Changing Demographics, Changing Approaches

The comparative youth of many of these fatalities is not the only statistic that stands out. As Lord Fowler emphasised, there has been a profound shift in the global disease population profile since he led the UK’s response to the pandemic in the 1980s: “In the 1980s, when I was first doing this, we tended to have discussions in terms of gay sex and men. But in fact, at the moment, what gives me the most cause for concern is the amount that AIDS is affecting young women and girls.”

With a changing patient population, public health requires changes dramatically and as Lord Fowler noted, these changes could have potentially transformative effects on the societies of low- and middle-income countries in particular: “It is established that if young girls stay at school—that they don’t leave at 12 but leave at 18—the HIV incidence goes down by about half.”

According to research from the Global Partnership for Education, women with post-primary education are five times more likely to be educated on the topic of HIV and AIDS. Fundamentally, the final push towards the goal of eliminating AIDS by 2030 is inexorably linked to gender equality and the empowerment of women and girls the world over.

The link is clear and has been borne out in the data countless times. As was reported by UNAIDS, “When Botswana extended mandatory secondary education, it found that each additional year of schooling after year nine was associated with a 12% reduction in girls’ risk of acquiring HIV.”

Lord Fowler at UN AIDS
Left to right: Suki Beavers, Director of Gender Equality, human Rights and
Community Engagement at UNAIDS, Lady Fowler, Lord Fowler, Winnie
Byanyima, Executive Director of UNAIDS

Fighting in the Dark

Significant progress has been made in the global fight against AIDS, not just since the 1980s, but much more recently. In 2021, an estimated 1.5 million people worldwide acquired HIV, marking a 32% decline in new HIV infections since 2010.

However, as we approach the end of the pandemic, reductions in transmission only decelerates and the final hurdle is often the hardest. As Lord Fowler notes, a significant challenge to eliminating AIDS entirely is the issue of discrimination: “One of the major issues is the discrimination of nations—not recognising or legalising homosexuality, for example.”

Unsurprisingly, such nations are unsuccessful in eliminating HIV and AIDS with intolerance, which only exacerbates the problem. When people have reason to fear for their safety—if they were to get tested for HIV/AIDS—the problem is only driven underground. People go about their daily lives, unaware that they have acquired HIV/AIDS, and thus, they are more likely to pass it on to others.

Moreover, there is a reluctance amongst some governments to even engage on the issue: “We’ve got many of the solutions but we haven’t got the ability to deliver them. That’s partly finance but it’s also partly the fact that many governments are not even prepared to look at [HIV/AIDS].”

In the face of this discrimination, and with the cuts in contributions to the Global Fund, Lord Fowler did not express great optimism that the international community would hit the target of eliminating AIDS by 2030. With the gloomy global economic outlook, he also predicted a slow-down in progress:

“I think it’s going to be a year of less progress than we might have otherwise made. That means, in human terms, there are going to be people who are denied treatment who could have had it and people are going to die when they don’t need to die. That’s the reality of it.”

“We Mustn’t Give Up Now”

Despite the challenges we face, Lord Fowler remained adamant that the fight must go on and, in fact, he expressed real and concrete sources for optimism. One such cause for hope was the recent appointment of Andrew Mitchell as Minister for Development: “I don’t think the area could have a more persuasive or persistent advocate.”

However, with his hope came a sober acknowledgement of the magnitude of the moment, as Lord Fowler reflected:“We’re so near to actually being able to get rid of AIDS and the financial burden that can go with that, that it would be foolish, even on an economic basis, to give up.”

Indeed, decades of progress can be undone by years of inaction. With the finishing line in sight, it is critical that the international community does not lose focus and continues with the same dedication that has characterised the effort over the past four decades.

Final Thought

With prevailing economic conditions plunging economies across the world into recession, there are few harder times to be making the case for international development spending. However, Lord Fowler was clear:“It’s a bad time for [Sunak] to take over in this area but it’s an opportunity, as well, to show that this country remains something of an exception to the gloom that has been around on AIDS.”I

There is a real and concrete possibility for AIDS to be the first disease ever eliminated in human history without a vaccine. To do so would be a remarkable feat for public health, but also for international cooperation. If the Government wishes to advance a vision of a ‘Global Britain’ post-Brexit, it must ensure that it is at the forefront of this effort.

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