As the global financial crisis tightens its grip on national purses, news emerges that some experts are questioning the amount of money spent on HIV/AIDS and asking whether it might be better spent fighting other health crises, but the message from the United Nations is clear: don’t cut support for AIDS.
Today, 1st December 2008, marks UNAIDS’ 20th anniversary of World AIDS Day, which this year carries the theme “Lead – Empower – Deliver”, highlighting the importance that political leadership will make in sustaining the fight in the current financial downturn, and celebrating the role that leadership has played at all levels of society, said a statement from the joint United Nations programme on HIV/AIDS.
At the same time however, other voices are raising questions about whether the attention and the money is being rightly prioritized.
One expert, Roger England of Health Systems Workshop, writing in the British Medical Journal earlier this year asked whether there was still a need for UNAIDS, suggesting it should be disbanded and its budget reassigned to fighting an illness like pneumonia which kills more children every year than AIDS, malaria and measles put together. He said the global industry that has grown around HIV/AIDS is too big and out of control.
Another expert who studies spending in health care, Jeremy Shiffman who is based at Syracuse University in New York, told the Associated Press that:
“AIDS is a terrible humanitarian tragedy, but it’s just one of many terrible humanitarian tragedies.”
The news agency also reported that in 2006, health officials in Rwanda commented that 47 million dollars went to HIV, while only 18 million went to malaria which kills the most people, and 1 million to children’s diseases.
The response from the UN is that HIV infections could resurge if the global finacial crisis caused nations to cut back on AIDS prevention.
According to Reuters, Paul De Lay, a director at UNAIDS told the press that development programmes were under threat, but the world must maintain its current support, or what will happen is that the next four or five years will see:
“A resurgence in new incident infections and we won’t be able to scale up the treatment that is clearly going to be needed as more and more people become symptomatic and need access to drugs.”
AIDS has killed 25 million people since the disease came to light in 1981. Every year around 2.7 million people are infected and around 33 million people, most of them in sub-Saharan Africa, were living with the virus at the end of 2007.
De Lay said that for every two people who get the life-extending drugs, five new people are infected. And while 9.7 million people need the treatments, only 4 million get it.
As newer and cheaper drugs are developed, the hope is that more people can be reached. For example, De Lay say they were expecting that a new class of antiretroviral, the integrase inhibitors, will help to “improve patients’ response and make it easier and easier to take the drug regimens”.
De Lay said while it was valid to question the place of AIDS in world priorities, and that it looks like a turnaround has been achieved, it is still very early days and too soon to think the epidemic is now under control.
“We have an epidemic that has caused between 55 million and 60 million infections,” said De Lay. Pulling the rug from under it would be disastrous, he told the press.
But the dissenting voices will not go away and as the global economic crisis pinches harder, they will get louder.
Helen Epstein, an AIDS expert who has worked with the World Bank and UNICEF told the Associated Press that:
“There needs to be a rational system for how to apportion scarce funds.”
Other experts complain of how difficult it is to compete with AIDS when trying to raise money for other causes. John Oldfield, senior executive of Water Advocates, a Washington DC organization that promotes clean water and sanitation also told the Associated Press that although diarrhea killed five times as many kids as AIDS, “nobody wants to hear about diarrhea”.
But De Lay said the answer was not to re-allocate the money but to boost it.
Executive Director of UNAIDS, Dr Peter Piot, whose term is up at the end of this year, as part of his World AIDS Day 2008 message, said:
“Let’s not forget that AIDS is not over anywhere. Indeed, on World AIDS Day 2008, there are as many reasons for concern as for celebration.”
“First because we have to find ways to sustain what has been started, to maintain the momentum at a time of a major economic and financial crisis. Second because what we’re doing still isn’t anywhere near enough – in terms of both HIV prevention and treatment. Third because it is increasingly clear that AIDS is a complex, long wave event that also requires a long-term response – including action to secure human rights, eliminate gender inequalities, and strengthen health and social systems.”
Sources: UNAIDS, Reuters, Associated Press .
Written by: Catharine Paddock, PhD