The world last year spent about $13 billion to fight AIDS, and there are warnings from many quarters that the funding is entering a period of stagnation. But in a presentation today at the Global Health Council’s annual conference in Washington, D.C., an economist predicted that spending in 20 years could rise well above current levels, ranging from $19 billion to $35 billion a year.
And that’s precisely why donors and recipients need to engage in serious discussions now about the AIDS response and who will be paying what, said Robert Hecht, managing director at Results for Development Institute, a Washington-based group of development experts.
Paul Bouey, U.S. deputy global AIDS coordinator, told an audience of 150 people that those discussions were well under way.
Bouey said that the research, done under the auspices of the aids2031 group, “lays out that there is a huge global need and has to be a huge global response. We get caught up in the short-term funding needs too often. And that brings us to these conversations we’re having currently with the countries. How do we support longer-term needs of countries? How do we correctly balance our response? We need to move much more closely with the countries’’ priorities, he said.
Still, two African leaders in the AIDS field — David Apuuli, director general of the Uganda AIDS Commission,and Benson Chirwa, director general of the National AIDS Council in Zambia – expressed concern about whether the international funding would last, leaving them vulnerable with a growing number of people on AIDS treatment and little resources to pay for them.
“I think we are heading for a crisis,’’ Apuuli said. “Not only my country, but neighboring countries, Kenya and Tanzania, as the amount of money flattens and the numbers of those who need treatment rises. The money required for those who need it is way beyond the budgets in these countries.’’
Hecht presented forecasts that showed in 20 years many countries’ AIDS bill would be less than 1 percent of projected GDP, but in some Eastern and Southern African countries, the bill would be 3 to 4 percent of GDP – a staggering amount for poor countries.
Chirwa’s response: “We should no longer be talking about a global pandemic, but focused epidemics,’’ he said. “I am advocating that where the epidemic is worse, that’s where the money should go. The funders should focus their money in these countries, including Zambia.’’
But where is the money going to come from?
Moderator David de Ferranti, president and founder of Results for Development, tried to steer panelists toward this point. “Can we raise that much money?’’ he asked them. “Can the gap be closed? And if we can’t, where are we headed?’’
Bouey replied: “Those are some of the toughest questions. It comes down to looking at efficiencies, how do we actually ensure that things are (having an impact.) In some cases, that may mean reducing the supply chain from four systems to one system; in another, it may mean getting more generic drugs in place. And with prevention, we are targeting what are known prevention strategies to more effectively get resources to those places.’’
Alvaro Bermejo, executive director of International HIV/AIDS Alliance, who also served as a member of an aids2031 working group, said during the question-and-answer session that AIDS advocates were missing an opportunity not pushing for a dedicated levy from financial transactions to fund global AIDS efforts. “We are giving up the fight before we even start,’’ he said.
Peter Piot, the former UNAIDS executive director who headed the aids2031 efforts, also asked the panel whether each had launched a debate on “these tough choices ahead.’’
Rifat Atun, director for Strategy, Performance and Evaluation Cluster at the Global Fund to Fight AIDS, Tuberculosis and Malaria, said that debate was well under way in his organization. But he also lamented that groups still don’t have enough accurate data to know what is happening inside each country’s epidemic. “In many countries, we are still estimating prevalence,’’ he said, adding that measurement indicators have often “failed’’ or misled policymakers since AIDS was first identified nearly three decades ago.
Bouey, Apuuli, and Chirwa also said their organizations were discussing intensely what would be happening with future funding. But for the recipients, there is great worry ahead.
After the panel discussion, Apuuli said that Ugandan officials were perplexed about the signals from Washington that AIDS funding would stay flat for the next several years, and that a new program, the Global Health Initiative, would now provide a guiding framework for funding.
“It is like they put us out to sea with all these people on AIDS treatment, and now they are telling us, `Swim or sink,’ ‘’ Apuuli said.
Last year, the US spent $285 million to fight AIDS in Uganda, according to US figures. That accounted for 70 percent of all AIDS funding in the country.