What is sustainable about HIV/AIDS?

I’m currently attending a conference about sustainability in the HIV/AIDS sector, hosted by a prominent NGO that provides technical assistance to US Government funded organizations.  The opening session was quite interesting, addressing the topic of “What is the future for HIV/AIDS programmes in South Africa?”  It was a good crowd-attention getter, since everyone in the room had a job depending on the longevity of these programmes. 

The speaker had some timely, if not revolutionary, points.  Such as:

• HIV/AIDS programming to-date has focused on treatment rather than the social aspects of the dilemma
• As resources become more scarce (read: PEPFAR is turning down the tap), business-minded approaches are needed
• Proposed ‘silver bullets’ have mostly been bio-medical rather than social, ie why are we always talking about barrier methods and microbicides, rather than talking about sexuality and desire?  (I thought this was a pretty good question.)
• HIV/AIDS programming needs to be ‘mainstreamed’ (again read: PEPFAR is turning down the tap and GHI is going to get some of the pot too)

I’ll spend some time on the plane looking over my notes and getting some more comprehensive thoughts down, but my general thought is this: I understand that HIV is now a chronic disease and that we are moving into a “new era” of programming that needs to be sustainable and cost-effective.  But in my mind, there is nothing sustainable about a society that has 1.4 million orphans and 1 million people on ARV treatment. The funding required to manage an epidemic in a country such as this is bordering on 4 billion dollars per year and that, to my mind, is the definition of unsustainability in a developing country.  So who are we kidding when we attend “sustainability symposiums”?