The joint United Nations Program on HIV/AIDS, on which significant effort has been focused, is damaging health systems and distorting health financing, writes Roger England, Chairman of the Health Systems Network, in a View & Review feature released on May 9, 2008 in BMJ. As a result, he believes that UNAIDS should be closed down immediately.
He writes that the amount spent on HIV in comparison the amount spent on other diseases in disproportionate. Instead, England believes that the money would better invested in such efforts as strengthening general health services, and in funding action for other diseases, such as pneumonia and diabetes, that kill more people and might have more effective intervention tactics.
HIV globally accounts for 3.7% of mortality. However, 25% of health aid and a large proportion of domestic expenditure is allocated for HIV interventions. England points out that the global catastrophe once predicted with the AIDS epidemic has not occurred, and in comparison draws attention to the fact that global HIV deaths do not overtake the number of deaths of children under five years old in India. He claims that its recognition through a division of the UN, the disease has become more than just an ailment to prevent and cure. “With its own UN agency, HIV has been treated like an economic sector rather than a disease.”
England argues that billions of pounds have been wasted by national AIDS commissions in the UK and in the funding of obscure projects and disciplines. This money should be used to strengthen public health systems in developing countries that could achieve controlled transmission of HIV.
In addition, he says, the enormous attention paid to HIV in terms of aid has created parallel financing systems, employment structures and organizational setups that have overall weakened national health systems and put much needed structural reform to the side. Additionally, HIV-dedicated funding provides no incentive for sustainable country systems, achieves poor value for the money given, and increases the country’s dependence on aid.
He puts forth that only 10% of the ten billion US Dollars per year which is dedicated to HIV is actually needed for the two million people receiving treatment presently for free. By putting the remainder of HIV funding to general health budgets, a huge step forward could be made in developing country health systems, allowing them to prioritize and improve prevention and treatment of a whole range of diseases.
Finally, he says, a UN agency dedicated to a single disease is a liability, so UNAIDS needs to be shut down. He says this “not because it has performed badly given its mandate…but because its mandate was wrong and harmful. Its technical functions should be re-fitted into WHO, to be balanced with those of other diseases.”
The writing is on the wall for UNAIDS
Roger England
BMJ, 10 May 2008, Volume 336, 1072
Written by Anna Sophia McKenney