Washington – The debate between those who favour investment in AIDS treatment and those who favour investment in its prevention came to the forefront Thursday at a U.S House of Representatives hearing on U.S. investments in HIV/AIDS in Africa.
International health organisations working to help check the spread of AIDS in Africa said meagre increases in funds from the U.S. government this year would be a step backwards. Some experts also emphasised that prevention must get appropriate attention in any fight against the disease.
New patients will be turned away if AIDS treatment stagnates at this year’s level since demand for antiretroviral (ARV) drugs is continuing to grow in Africa, said experts from the health groups. The concern stems from U.S. President Barack Obama’s 2011 budget request, which includes a 180-million-dollar increase in bilateral AIDS funding, up 2.2 percent from the previous year.
“Under-funding these initiatives will prohibit us from seizing major opportunities in our global AIDS response,” said Joanne Carter, executive director of the Educational Fund RESULTS and a board member of the Global Fund to Fight AIDS, Tuberculosis and Malaria.
Representatives from the organisations spoke at a hearing of the House Subcommittee on Africa and Global Health.
In 2003, President George W. Bush announced the President’s Emergency Plan For AIDS Relief, or PEPFAR, which pledged 15 billion dollars over the next five years to combat HIV/AIDS, TB and malaria in 15 African countries. The U.S. renewed this commitment on Jul. 30, 2008, by reauthorising PEPFAR, this time with 48 billion dollars to use from FY 2009 through FY 2013.
Obama’s 180-million-dollar increase will come up against seven to 10 percent inflation in Africa, Carter said. It would need to be 2.2 billion dollars more to reach the level pledged in the 2008 PEPFAR reauthorisation, she said.
Obama’s budget also proposes a 50-million-dollar cut to the Global Fund and a 5.0-million-dollar increase for bilateral programmes addressing TB, one of the leading killers of people with HIV/AIDS.
The flat-lining of PEPFAR funds over the last two years has meant turning away new patients in Uganda, said Peter Mugyenyi, director and founder of the Joint Clinical Research Centre in Kampala, Uganda.
Roughly 940,000 people in Uganda are living with HIV/AIDS.
“New PEPFAR contract awards emphasise treatment for only those already on it and only very limited slots for new patients,” Mugyenyi said.
This is giving rise to the dangerous practice of sharing ARV drugs with family members, he said. This trend can give rise to treatment interruption that can in turn give rise to drug resistance.
While treatment of HIV/AIDS has gained funding support, funding of prevention has lagged behind. HIV prevention services were only reaching 20 percent of people in need in 2005, while coverage for key populations at higher risk of exposure to HIV was considerably lower, according to UNAIDS, the United Nations’ AIDS programme.
In a 2007 study, the agency said that bold leadership actions were necessary to increase coverage and bridge the prevention gap.
At the hearing, Norman Hearst, a professor of family and community medicine at the University of California, San Francisco, said he feared the threat now is the “prevention funds being siphoned away by treatment funds.” Uganda, for instance, made prevention a success story in the late 1980s and 1990s – long before any treatment was available – by convincing people to follow certain preventive measures, Hearst said. But now, the country has forgotten this history as a rash of foreign donations is ramping up AIDS treatment.
According to Hearst, the stagnating of the PEPFAR funds was inevitable as supply cannot meet the ever-increasing demand.
“PEPFAR needs to face the reality,” Hearst said, explaining unlimited funding cannot be bankrolled.
While health organisations chime in on the treatment versus prevention debate, they are also asking the United States, a major donor in the global fight against AIDS, to scale up funds.
On Wednesday, Bill Gates, the founder of Microsoft and co-chair of the Bill and Melinda Gates Foundation, attended a U.S. Senate hearing to seek support for the Global Health Initiative (GHI) and a global health aid budget bill proposed in 2009 by Obama.
Four million people in sub-Saharan Africa are receiving ARV treatment, up from 155,000 five years ago, mostly due to PEPFAR and the Global Fund, Gates said.
But the amount requested by Obama’s FY 2011 budget for health aid was a small fraction of the U.S. budget, he said.
While drug prices have dropped 48 percent from 2004 to 2008 levels, total treatment costs will need to decrease further to reach the largest number of people. But, said Gates, even price decrease will not be able to tackle HIV/AIDS in a feasible way unless the occurrence of new infections is checked.
“The harsh mathematics of this epidemic prove that prevention is essential to expanding treatment, and that stressing treatment without paying adequate attention to prevention is simply unsustainable,” Gates said.
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