What to do about HIV in a recession

As a banner at the World AIDS Conference in Vienna pointed out, AIDS is not in recession. Unfortunately, the countries funding the response to the pandemic are, and this is a worry.

The global recession threatens our reponse to HIV in two ways. Firstly, it's restricting countries' abilities to respond to their domestic epidemics in the way they might have done in wealthier times.

When deciding priorities for limited funds, government departments often swing the axe where there will be least public resistiance. This never bodes well for unpopular issues, and HIV is down there with the best of them.

So we must make sure vulnerable people with HIV in the UK don't have the services they rely on cut from under their feet as we struggle to balance the books.  Campaigners must show how investing in effective HIV services saves time and money elsewhere

Decisions about where to cut are rarely taken in the round either, so one department may cut funding which makes another's job impossible. It's one of the reasons UNAIDS asks every country to have a cross-government HIV Plan.

We don't have one in the UK, nor is there a realistic likelihood of one any time soon. We're busy tackling the deficit.

So though the UK had a strong start on HIV back in the 80s, we could so easily lose critical ground by cutting vital services or health promotion initiatives.

Canada is the salutary lesson here - they defunded needle exchanges when they wanted to save money and their epidemic rocketed. Their cost-saving cost them dear.

Secondly, the global recession means donor countries have less money for efforts to tackle the pandemic in lower and middle-income countries. This could be very bad news.

What will happen to people whose HIV drugs and services rely on fragile economies outside their borders?

We've spent recent years scaling up access to HIV treatment worldwide. Imagine living in a village or town where friends and family had just stopped dying - could we really turn off the supply? 'Sorry, this machine is temporarily out of order,' won't cut it I suspect.

So there are three things we must do to make sure we don't lose ground we've worked so hard to gain:

1.Find cheaper and easier ways of testing and treating people for HIV. This means you, wherever you live in the world. If you're stuck for ideas, ask your local community or voluntary organisation. I bet they'll tell you how.

2.Find new ways of raising global and local funds to support vital work. This is easier said than done, but I heard several good ideas discussed in Vienna.

3. Step up prevention efforts.  There's no vaccine or cure for HIV, but we have learned a lot about different ways to prevent HIV spreading. With lifetime treatment costs for each HIV infection currently £350,000 in the UK, we can't afford not to.

It isn't all doom and economic gloom. The World AIDS Conference was a dazzling exposition of how far we've come, how much we've learned, what we must do next.

Money has never been more important. It's not 'the economy, stupid', it's how we deal with it.