#HLM2016AIDS and Tanzania’s Prisoners’ Dilemma



I decided to join Twitter a couple of weeks ago, something I have resisted for years. Universities see it as a good way of promoting research and engaging the public: I see it as a rabbit hole that I don’t need in my life. However I thought it would be a good way of linking with distribution companies for PILI and promoting the film to my 150 followers (@DrSophieHarman if you want to up that number to 151).

Like those before me, I have discovered Twitter makes the world look busy and vitally important – were all of these high level meetings happen before Twitter? And all of the time? Since joining, there has been the World Health Assembly (okay, I knew this happened every year) that had a lot to say about the future of HIV/AIDS and now there is the High Level Meeting on Ending AIDS, or in Twitter speak #HLM2016AIDS.

The purpose of #HLM2016AIDS is to galvanise and build political will among member states of the UN, the private sector, researchers, philanthropists, and civil society organisations to continue to finance and advocate for ending AIDS. The good years of HIV/AIDS financing were the noughties – for ten years everyone who was anyone would finance an HIV/AIDS project, from the big hitters of the Global Fund to Fight AIDS, Tuberculosis and Malaria and the US PEPFAR programme, to consumers of (RED) iPods (yes ipods, this boom was nearly ten years ago) and MAC lipsticks. This funding went to the core areas of the HIV/AIDS response: care and treatment, prevention, support for people living with HIV/AIDS, innovation.

People living with HIV/AIDS in Tanzania are able to access treatment because of this global response. There have been efforts to see how the government can co-finance treatment, however this has led to an ongoing stand-off between the government of Tanzania and donors that support treatment and prevention packages. Realistically, for people to remain on treatment, and for prevalence of HIV/AIDS to be in decline, it is the outcome of meetings such as #HLM2016AIDS and global commitments to keep the money for treatment flowing that matter.

The global HIV/AIDS response currently faces a prisoner’s dilemma – large donors want to spread their efforts in global health to other areas such as pandemic preparedness and antimicrobial resistance, but  are nervous about pulling away from HIV/AIDS and thus unravelling the gains that have been made. Institutions that support the HIV/AIDS response (UNAIDS, Global Fund) are keen to use play on such nerves to keep donors interested.  Low to middle income countries such as Tanzania do not want to carry the burden of treatment costs alone as it is an expensive budget line that they would rather not pay for. It is therefore in the interests of the government to keep negotiations over willingness to pay ongoing so donors keep investing so as not to reverse any previous progress.

Where PILI comes into all of this is that the film shows the progress and limitations in access to treatment, stigma, prevention, and the everyday structures and risk that provide context to disease and well-being. #HLM2016AIDS will impact on the lives of people living in Miono: without a commitment arising from this meeting, funding to HIV/AIDS will continue to decline so in turn free treatment and the systems in place to support access, will in turn decline.

For Tanzania, the current system of HIV/AIDS financing is unsustainable. The government knows this, donors know this, however given the potential cost to the government to support treatment there is a wilful filibustering in dealing with the issue. Awesome scholars such as Michelle Remme are working on how to address this through economic modelling, however as with most things it is not only the economics but the politics of HIV/AIDS financing that come in to play.


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