Law of Unintended Consequences

Letting you know up front some of this content is tough.

Today is World AIDS Day. I probably wouldn’t have written about it had it not been for Bono’s recent appearance on Jimmy Kimmel. (U2 fan from way back, Achtung Baby and *gasp* Zooropa, favorites.) (RED) Campaign spokesperson since its inception, Bono talked about this year’s campaign, which raised $500 million dollars. At the end, Kimmel cut to a video of the “currently unemployed” President Obama, who says, “Hi everybody. This World AIDS Day, everyone has a role to play.” Huh? I thought we had this. And here we are.

The 2014 Scientific American article, “Food Security and the Fight Against HIV/AIDS,” corroborated in fact much of what I guessed about AIDS trends, noting several achievements: new infection decline, 61% accessibility to antiretroviral therapy (ART), AIDS-related mortality dropping from its 2.3 million peak in 2005 to 1.6 million in 2012. However, declines, accessibility…these things aren’t happening across the board, and one of the drivers of inequity in sub-Saharan Africa is…you guessed it, food insecurity. Predictably, those infected with HIV/AIDS have higher medical expenses. They miss work. All of which exacerbates food insecurity and affects outcomes. Also predictable but something I hadn’t let myself think about much, hungry people engage in transactional sex, increasing transmission.

US trends are even better, but inequity still complicates. People of color are disproportionately affected, and a highly publicized 2010 CDC study suggests infection among heterosexuals living in inner-cities most depends on poverty; rates doubled among those living below the poverty line. The surveyed were not IV drug users, though they could have been more proximate to them. The CDC 2016 “Today’s HIV/AIDS Epidemic” fact sheet blurb about poverty as an exacerbating socioeconomic factor implies an additional reason: "Those who cannot afford the basics in life may end up in circumstances that increase their risk for HIV infection." (Emphasis mine.) Transactional sex.

Last Fall, Urban Institute and Feeding America released details of another highly publicized study, “Impossible Choices: Teens and Food Insecurity in America”. Focus group conversations with teens in ten communities across the country revealed, "Teens in all 10 communities talked about some young people 'selling their body' or using 'sex for money' to make ends meet. However, these themes were strongest in high-poverty communities."A young woman from Portland, OR, told researchers, “It’s really like selling yourself. Like you’ll do whatever you need to do to get money or eat.”

I warned you.

Back in Africa…Having recognized systemic inequity as the barrier in the fight against HIV/AIDS, over the last decade PEPFAR (the United States Government’s President’s Emergency Plan for AIDS Relief), UNAIDS (the joint United Nations program on HIV/AIDS), and WFP (World Food Programme) have facilitated increased adoption of food and nutrition security policies within larger HIV and AIDS policies. Among the $2.2 billion in proposed budget cuts to our global world health program, President Trump proposes to cut PEPFAR (an agency begun by George W. Bush) funding by 17% with total cuts of $800 million to the HIV/AIDS global health program. One day ago, the (One) Campaign cited a Kaiser Family Foundation report projecting these cuts could result in nearly 300,000 deaths and more than 1.75 million new infections each year. Organizations everywhere, including the Gates Foundation, are ringing alarm bells; they see proposed cuts as a sign of US retreat from the global fight against AIDS.  

Today, back in the US, the GOP is lining up votes for a tax bill analysts say will add $1 trillion to the deficit, and anti-hunger organizations are ringing their own alarm bells. It remains to be seen whether the bill will pass and if so, how lawmakers will balance the federal budget. What seems certain is withdrawal of funds for the global fight against HIV/AIDS will cause new infection rates to rise again after a decade of retreat, and withdrawal of funds to support hungry folks will mean more hungry folks. Some of those will do whatever they need to do to feed themselves and their families.