Global Economy Crimps Contributions to Developing Nations for Drugs Recently Shown to Curb Spread
Wall Street Journal
By BETSY MCKAY And MARK SCHOOFS
In advance of a major United Nations meeting on the global AIDS epidemic, public-health leaders face a paradox: New evidence suggests the epidemic can finally be controlled, but that would demand increased spending at a time of severe global budget restraints.
Preliminary estimates show that funding from donor nations to fight AIDS in developing nations actually fell in 2010, the first decline ever in the battle against HIV, which currently afflicts 33 million people world-wide.
The U.N. High Level Meeting on HIV/AIDS, to be held June 8-10 in New York, is designed to chart how to fight the disease through 2015. A key point of contention: Whether to set specific targets for how many people to put on AIDS treatment.
Any such targets will not be met unless new money is found to buy medicine for more people after the 2010 funding drop. Last year was “a real decrease,” said Jennifer Kates, director of Global Health and HIV Policy at the Kaiser Family Foundation, which tracks global HIV spending with the Joint U.N. Programme on HIV/AIDS, or UNAIDS.
Ms. Kates declined to provide specific figures, saying they were still under analysis. But she said “a major factor” in the decrease appeared to be the global economic crisis.
Earlier this month, a landmark study proved that AIDS drugs, known as antiretrovirals, not only restore health to people with HIV but also make them strikingly less infectious. Compared with people not yet taking drugs, those on treatment were found to be more than 96% less likely to transmit the virus to their sexual partners.
The study was funded by the U.S. National Institutes of Health and led by Myron Cohen, director of the Institute for Global Health and Infectious Diseases at the University of North Carolina at Chapel Hill.
AIDS experts call treating patients to slow the spread of the epidemic “treatment as prevention.” Combined with other new prevention tools, many scientists believe it could turn the tide on an epidemic that currently infects more than 2.5 million people each year.
At the end of 2009, about 5.2 million people were on treatment, and the world spent about $15.9 billion that year, with a little less than half coming from donor nations, according to UNAIDS and Kaiser estimates. But another 10 million patients needed treatment, and the funding gap exceeded $7.5 billion.
Newer estimates, based on more efficient delivery of care, suggest the gap might be as narrow as $6 billion, according to estimates prepared by a group of prominent HIV experts.
But the global economic slowdown has taken a toll. For the first time, the multinational Global Fund to Fight AIDS, Tuberculosis and Malaria has seen some nations fail to meet their pledges. Italy did not pay anything for 2009 and 2010, and thus is more than $192 million in arrears, according to the Global Fund.
An Italian government official wrote in an email, “Budget constraints have been slowing down the process of paying the amount pledged for the time being. We are also confident that we will be able in the future to increase our contributions.”
The Netherlands reduced its 2010 pledge by about $41 million, citing the economic slowdown, according to spokesmen for the Global Fund and the Dutch Minister of Development Cooperation.
U.S. funding for global AIDS efforts stayed flat, with $6.6 billion appropriated in 2010, according to a Kaiser analysis, and the 2011 budget keeps roughly the same amount of money. The Obama administration has requested $6.9 billion in its 2012 proposed budget, according to Kaiser, an increase of about 4.5%,
The new science has prompted the administration to undertake a “rigorous” internal dialogue to determine what targets and commitments would be needed to get enough people on treatment to reverse the epidemic, and what the U.S. contribution should be, said Eric Goosby, the U.S. Global AIDS Coordinator.
“What I’m now committed to doing is shepherding the dialogue within [the government] quickly,” he said. While the science of how best to implement the new study on the ground needs to be carefully examined, he said, it also “needs to challenge the way we are doing business.”
The U.N. meeting is expected to endorse a declaration setting forth how to combat the epidemic. A major contention, according to people familiar with the negotiations over the declaration, is targets for how many people will be treated. Activists want at least 15 million by 2015.
“The U.S. strongly supports setting ambitious and realistic global goals moving forward,” a U.S. government spokesman said, but did not give a figure.
The U.S. has set its own goal for its money: treating over four million people in poor countries by 2013. The U.S. appears ahead of schedule, with 3.2 million patients on the drugs as of September 2010. Asked Wednesday how many people the U.S. now expects to put onto treatment by 2013 with current budgeting, Dr. Goosby declined to say.