HIV/AIDS Policy Discussions

I assume some of you have already heard about this, but lately there have been some interesting goings-on in the HIV/AIDS funding world. Well, once again, perhaps “interesting” is the wrong word – “unfortunate” might be more appropriate. (See NYT articles for a briefing: one details the deteriorating situation of access to treatment in Uganda; the other is an editorial on the funding shifts taking place). Basically, there is beginning to be a large shift in the donor world from supporting HIV/AIDS initiatives to combating the “neglected” tropical diseases and focusing on maternal and child health instead – the thinking being that you can actually save more lives by concentrating on these “fixable” problems rather than dumping all the money into HIV/AIDS work, which, after decades and decades, is still a giant uphill battle. Another issue is that someone with advanced HIV will need to be on drugs for the rest of their life, and the cost of these drugs is over $10,000 per person for a lifetime – whereas treating other diseases and ailments can cost just a few dollars per person. Thus, on some level, it has turned into a sad “cost-benefit” analysis to shift away from spending so much money on HIV/AIDS programs.

I can certainly appreciate some of the thinking behind the funding shifts, but I really don’t think the world can turn away from HIV/AIDS. HIV is so widespread, and it’s not going away anytime soon even as it is, with current donor levels relatively high. More people get infected every year (approximately 1,000,000 new infections per year, in fact) than get access to treatment. As Mitch, the founder of m2m, always says, “you can’t treat your way out of the epidemic” – part of the reason why our prevention programs are so important. But prevention is so, so hard when you’re not dealing with the mother-to-child scenario. (Hell, its hard even with the mother-to-child relationship, which is a seemingly simple one to navigate...) I’m not saying it’s hopeless, I’m just saying with the reality of HIV stigma issues and gender dynamics in many parts of Africa, new infections aren’t going to go away anytime soon. It’s just so tragic – and scary – to think that HIV/AIDS programs are going to get even less money and attention in the future. Combating the disease is such an integral part of addressing other issues afflicting populations in Africa, such as poverty and poor maternal and child health – I don’t see how suddenly deciding to focus only on other diseases and health issues while shifting attention away from HIV will actually make for a healthier population, given the magnitude and continuing spread of HIV.

One of the NYT articles talks describes the situation in Uganda, where access to antiretroviral therapy had previously increased remarkably over the past several years, but now people in desperate need of treatment are literally being turned away from hospitals and told there is nothing that can be done for them. I cannot imagine being in that position. 33 million people are infected world-wide, with 14 million at a stage where they require treatment – but only 4 million people are on treatment. The decision of the Ugandan government to buy $300 million dollars worth of fighter jets from Russia (as detailed in the article), rather than spend money on helping its own population stay alive, is truly despicable and it’s understandable that donor nations want to see governments take more responsibility for fighting HIV/AIDS. But it’s just to distressing to think about the real people caught in the middle between donor governments (who want to spend their money elsewhere, or who don’t want to donate to difficult governments, or who can’t afford to donate as much given the state of the global economy in recent years) and their own governments (who aren’t capable or willing to support HIV/AIDS initiatives on the scale that is needed). I really wonder what will happen with HIV/AIDS in the years to come.