HIV and AIDS in 2030: A Choice Between Two Futures

Other Voices

While we have made enormous progress in the HIV response in many countries, we are not on track to end AIDS. Barstow’s book shows the critical juncture the global community faces in turning the tide on the epidemic. Barstow’s message is both startling and clear: we must act now to reboot and recharge our efforts to deliver sustainable results for people and communities across the world.

—Professor Peter Piot

Director, London School of Hygiene & Tropical Medicine Founding Executive Director, UNAIDS

David Barstow’s book is a must read for anyone who cares about the world’s collective conscience and future. In creative and compelling fashion Barstow presents the stark choice and moral imperative that confronts us to not only reverse the HIV and AIDS crisis but to end it.

—Rev. Adam Taylor

Executive Director, Sojourners

Author, Mobilizing Hope: Faith-Inspired Activism for a Post–Civil Rights Generation

The HIV response has been one of the most successful in the history of public health. If we act now, we can get to the end. If we do not, history will not treat current policy makers well.

—Amb. Mark Dybul

Professor of Medicine, Georgetown University

Co-Director, Center for Global Health and Quality

Former Executive Director, The Global Fund to Fight AIDS, Tuberculosis and Malaria

The World Council of Churches supports David Barstow’s book HIV and AIDS in 2030: A Choice Between Two Futures and has chosen the future where the faith community remains faithful to ending HIV and AIDS because it is a moral and Biblical imperative. Accordingly, the World Council of Churches reaffirms the theological foundation of the Church as a healing community that was verbalised in the 1986 Executive Committee statement AIDS and the Churches; recommits to the 2016 Pastoral Letter Churches Recommit to Accelerate HIV Response; recommits to playing an active and leading role in ending HIV and AIDS; urges churches, faith communities and other religious institutions to likewise recommit to playing their parts in ending HIV and AIDS, keeping the presence, lived experience and participation of people living with HIV central in their ministries. Finally, the World Council of Churches urges the world’s leaders to strengthen the global response and funding to ensure that HIV and AIDS are eliminated as threats to public health by 2030.

—Prof. Dr. Isabel Apawo Phiri

Deputy General Secretary: Public Witness and Diakonia,

World Council of Churches

If we needed a wake up call, here it is. Two Futures smacks its readers with the mirror Barstow wants us all to face, asking everyone to own up to her role in finally ending AIDS. And the legacy of HIV ultimately will have a ripple effect across multiple global health responses modeled after this success story, not only those affected by the disease and their allies. You have been warned.

—Loyce Pace, MPH

President and Executive Director, Global Health Council

In 2001, when World Vision was ramping up its AIDS prevention initiatives, I called HIV a Doomsday Virus; the kind of apocalyptic pathogen that is the stuff of disaster movies. It stalked its prey silently, passed from husband to wife and mother to child, showed no symptoms for months or even years so that it could continue to be transmitted unnoticed, and was effectively 100% fatal. To make it worse, because it was spread through sexual contact, it became taboo to even discuss it openly. Only a full-court press by the nations of the world could stop it. And, remarkably, the world responded and began to win the battle to raise awareness, slow its spread and care for its victims. But HIV, like a wolf at our door, doesn’t give up. David Barstow’s book lays out two possible storylines based on the two possible choices the world might make. One is the Doomsday scenario of terrible human suffering, and the other is the victorious ending where humanity ‘wins’ and the threat is averted. We can write this next chapter, but what will we write? The choice is ours to make.

—Richard Stearns

President Emeritus, World Vision US

The next decade will truly decide if we will end this epidemic in the U.S. and everywhere. It is a public health, public policy, and human rights imperative that Barstow knows well.

—Jesse Milan, Jr.

President and CEO, AIDS United

We’ve made a commitment to bringing HIV and AIDS under control by 2030, and we know how. Not to do so is a policy choice—and a policy failure—with tragic consequences.

—Amb. Jimmy Kolker

Former Chief of HIV/AIDS Section, UNICEF

In search for why and how the evolution of HIV/AIDS epidemic could take a better turn?

Two Futures provides sobering insights into the unintended effects of global action and inaction in addressing the HIV/AIDS epidemic. By the effective use of anecdotes, fiction and imageries, David paints a paradoxical picture of avoidable regrets for past inactions/missed opportunities, and the potential positive returns on focused investments in achieving the HIV/AIDS 95-95-95 goals by 2030

David portrays the present and future perspectives in provocative tone, highlighting barriers to be overcome and opportunities to be leveraged in addressing the HIV/AIDS epidemic. Over the years, due to several impactful initiatives aided by close intimacy with communities, faith-based/inspired organizations/networks have been frontline actors and innovators in making sustainable progress in achieving HIV/AIDS goals in sub-Saharan Africa. Hence, the Author’s gracious recognition of the indispensable role and positive influence of faith-based leadership and religious assets in changing the HIV/AIDS trajectory should serve as an impetus for faith-inspired organizations/networks, especially in sub-Saharan Africa.

In many ways, David Barstow’s book represents the much-awaited prophetic voice of global conscience, convening forum and advocacy platform for global collective action towards ending the HIV/AIDS epidemic with the fierce urgency of now!

—Peter Yeboah

Chairman/President,

Africa Christian Health Associations Platform

Dr David Barstow has been unrelenting in his fight against HIV and AIDS related stigma and discrimination. In his book, HIV and AIDS in 2030: A Choice Between Two Futures, he outlines the two possible trajectories. We, as faith communities, have a choice. We can win the battle if we stand and work together towards a future without AIDS. A future without AIDS is possible!!

—Rev. Phumizile Mabizela

Executive Director, INERELA+, International Network of Religious Leaders Living with or Personally Affected by HIV or AIDS

David Barstow imagines two futures: one where we succeed, and one where we do not. Success means saving millions of lives and will only happen if governments, civil society and the extensive faith community networks work together to mobilize policy and resources to bring HIV under control. We must keep our eye on the ball …

—Doug Fountain

Executive Director, Christian Connections for International Health

We must return to the sense of urgency and recharge our efforts. Barstow makes it clear the heavy price the world will pay for not doing so.

—Dr. Michael Merson

Professor of Global Health, Duke University

Author, The AIDS Pandemic: Searching for a Global Response

Thanks to a remarkable global effort, and the advocacy led by people living with HIV, we have made tremendous progress against HIV and AIDS. The end is in sight and we know how to get there. But as Barstow makes clear, we will only get there if we choose to do so and if we persist to the end. Faith leaders and communities are crucial to that choice and to that persistence.

—Jacek Tyszko, UNAIDS Senior Advisor for Faith Engagement

HIV and AIDS in 2030

Copyright © 2019 by David R. Barstow, PhD.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the copyright holder, except brief quotations used in a review.

Design by Meadowlark Publishing Services.

Cover illustration © Shutterstock.com/Yulia Ogneva.

Manufactured in the United States of America.

ISBN 978-1-7331424-0-3

ISBN 978-1-7331424-1-0 (e-book)

Published by GOYTS Publishing.

Published 2019

This book is dedicated to the many local religious

leaders who have had the courage to address the social

complexities of HIV and AIDS with love and

compassion rather than judgment and rejection.

Contents

Foreword

Preface

HIV and AIDS in 2030

How We LOST the War Against AIDS

Note from the Editor

Introduction

Fifty Years of the AIDS Epidemic

Why Did We Reduce Funding for AIDS?

How Important Were the Social Issues?

Did Religion Help or Hurt the Global AIDS Response?

Questions from the Audience

Closing Remarks

Panelists

Afterword

How We WON the War Against AIDS

Note from the Editor

Introduction

Fifty Years of the AIDS Epidemic

Why Did Funding for AIDS Fluctuate?

How Did We Address the Social Issues?

How Important Was Religion in the Global AIDS Response?

Questions from the Audience

Closing Remarks

Panelists

Afterword

It Is Not 2030, It Is Only 2019

Choosing the Future

Future and Present Perspectives

Appendix: Background Information

Acknowledgments

About the Author

Foreword

On a balmy Sunday evening in July, 2000, President Thabo Mbeki of South Africa stood up to warmly welcome 12,000 of us gathered in Durban for the biennial International AIDS Conference. He then proceeded to lay out his AIDS denialism manifesto, claiming that AIDS treatment was a CIA-Big Pharma plot. That manifesto cost nearly a half million South African lives before AIDS activists forced a policy reversal. Today, South Africa has the largest AIDS treatment program in the world.

In HIV and AIDS in 2030: A Choice Between Two Futures, Dr. David Barstow returns us to Durban three decades later for the 2030 International AIDS Conference. He provides two parallel transcripts of a plenary panel of government officials, academics, and secular and faith-based NGO leaders. One—set in a future in which AIDS has come back strongly—is a conversation of regret, frustration, disappointment, missed opportunities, and a feeling of failure for having lost the war against AIDS. The other—set in a future in which AIDS is no longer a public health threat—is a conversation of joy, achievement, and great satisfaction over having won the war against AIDS.

Dave and I met in June 2018, when we were asked to lead a dialogue on ending AIDS at the annual Christian Connections for International Health conference we were both attending. I’ve since come to greatly respect and admire Dave, who gave up a successful career in academia and business to fight the dehumanizing impact of HIV and AIDS stigma. He attributes that determined shift to a remark by activist/rock star Bono at a 2006 Christian leadership conference.

A self-described computer scientist turned AIDS activist, Dave deftly combines the meticulous attention to order and detail you would expect from a scientist with the persistence and passion for action you would expect from an activist. The fruits of this combination are evident in Two Futures.

Dave’s compelling and vivid approach lays out the implications of the choice confronting policy makers, funders, and other world leaders today. He worked closely with modeling experts and drew on published analyses, UNAIDS Fast Track projections, and the Global Fund Investment Case to ensure the win and lose scenarios and charts are plausible, well supported, and based on the latest data.

In human terms, the difference between the two futures couldn’t be more chilling: the current 1 million annual AIDS deaths could be reduced to less than 340,000 in the best-case win scenario or swell to nearly 1.5 million deaths in the worst-case loss scenario.

Is such a resurgence possible? I fear so, especially if AIDS fatigue and competing national and international priorities are allowed to undermine the gains from the unprecedented global response to AIDS over the past two decades.

We know how to end AIDS. At the time of AIDS 2000, the range of proven prevention methods was limited, the cost of AIDS medicines was sky high, funding was grossly inadequate, deaths were increasing, and families were on their own to care for the sick and orphaned. Today, we have a wide range of tools and resources for prevention, care, and treatment, from post-exposure and pre-exposure prophylaxis, to established global and national supply systems, to effective approaches tailored to the circumstances of key populations.

The benefits of ending AIDS