Funding squeeze, apathy risk another half century of AIDS
With enough money spent in the right way, the world could soon reduce new HIV infections to zero, but global apathy and the financial crisis mean it might take another 50 years to stop the AIDS epidemic, a U.N. expert has said.
At a time when HIV/AIDS efforts face an unprecedented decline in funding, Paul De Lay, deputy executive director of UNAIDS (the Joint United Nations Programme on HIV/AIDS), called on developing states to take more responsibility for tackling HIV in their own countries rather than relying on international assistance.
In Asia, for example, many countries - including Vietnam and India which are seen as economically stable - rely heavily on foreign funding, for up to 95 percent of their HIV budgets in some cases, according to UNAIDS.
Around 34 million people worldwide are living with HIV. Since AIDS emerged in the 1980s, more than 60 million have been infected and nearly 30 million have died, but there has also been significant progress.
New infections have fallen by about 20 percent in the past decade, deaths from AIDS-related illnesses have decreased, and about 6.6 million people - a little less than half the population needing treatment - were on lifesaving antiretroviral therapy (ART) at the end of 2010, De Lay told AlertNet on the sidelines of high-level intergovernmental meeting on HIV/AIDS in Bangkok this week.
“But it’s been a slow, steady decline,” he added. “If we continue at the same rate, we’re talking 40 to 50 years of this epidemic. Zero (transmission) is a long, long way off. So either we accept that or we have to do something different.”
That would mean focusing on the most effective ways of preventing the spread of HIV/AIDS, measuring programme impact and success differently, and boosting efficiency and cost-effectiveness amid limited resources, De Lay said.
AIDS activists say the goal of zero new transmissions is within reach, thanks to new technologies, the recent finding that early treatment can reduce the spread of the virus to others by 96 percent, and a three-fold increase in people receiving ART since 2006.
Yet donor cutbacks in 2010 led to a decline in international support for AIDS programmes for the first time in 15 years. The Global Fund to Fight AIDS, Tuberculosis and Malaria was forced to cancel its annual funding round for 2013 due to shortfalls for the first time in its 10-year history, suggesting that the trend may continue.
“We have to realise it’s unlikely we’re going to have a substantial increase of funds over the next four to five years, so how do we make the money we have more effective and efficient?” said De Lay. “In public health, if you mention the words efficiency and cost-effectiveness, you’re a pariah. But we have to do it.”
UNAIDS is aware it’s not just high levels of government debt in rich countries that is squeezing funding.
“There’s a fatigue about AIDS,” De Lay said. “The attention span of the aid and global health community and the politicians is short-lived, and there are other priorities.”
“The AIDS epidemic... opens up too many sensitive areas of society, culture and religion, so it’s easy for this epidemic to drop off the screen, and I think that’s the real danger,” he added.
VALUE FOR MONEY
Nonetheless, UNAIDS is hoping that funding for the global AIDS response will rise to $22 billion-$24 billion by 2015, a increase of around 50 percent from the $15 billion available in 2011.
De Lay urged programmes to target those most in need of treatment and prevention, and explore new methods of measuring impact.
In the Global Fund’s early days, success was judged by how quickly you could move money, he said.
“Just saying we’ve got 50 percent coverage of prevention programmes, or x number of condoms, doesn’t mean anything,” he said.
Evaluation of results should include patients’ quality of life, life expectancy and the sustainability of programmes, he added.
Other ways of boosting value for money include cutting down on the broader health and social activities HIV/AIDS programmes used to support and pushing for cheaper drugs, De Lay said.