AIDS funding ahead? Africans deeply worried

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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.

4 thoughts on “AIDS funding ahead? Africans deeply worried

  1. Laura

    I’m glad this issue was up for discussion at the Council’s conference. It’s really amazed me to see how drastically conversations have run dry. Although HIV/AIDS advocates have raised the alarm at the flatlining of funding, I’ve been astounded by the softness of the reaction from large organizations that I would have expected to garner resources for ramping up political discourse. For example, the ONE Campaign — a stalwart organization in the fight against AIDS over the years, completely buried AIDS issues in its special edition of the Globe and Mail produced in the run-up to the G8 Summit. UNAIDS is touting the campaign to prevention mother-to-child transmission, a worthy focal point, but other universal access issues are being downplayed. In fact, media and NGO coverage of UNGASS 2010 was practically nonexistent. And several other NGOs are busy reframing AIDS as a maternal health and reproductive health issue. It is, of course, but it’s far more than that. In fact, AIDS was the issue that gave other health advocates an inkling of what was possible if we organized ourselves and brought the issues to decisionmakers in clear, evidence-based, and dramatic fashion. I would really like to hear whether or not others think there will be a ralley of AIDS advocacy before it is too late, and AIDS issues are relegated to the global health back pages. HOW we move AIDS advocacy forward should be the question on the table, not whether or not to engage anymore.

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  2. linus ndonga

    ARVs, Lifelong Commitment: Traditional Medicinal Resources Holds Promise for Other Options
    HIV/AIDS remain critical global health issue. But although AIDS is a global health challenge, it has always assumed an African face, and eradicating it is predominantly an African challenge that threatens the continents ecosystems, growth, peace and security. The adverse economic and ecological effects of climate change are also deepening and worsening the situation of vulnerable social groups including, women, children, the aged, the poor and People Living With HIV/AIDS, and putting them at increased risk of infection or re-infection.
    Indeed, AIDS is a huge global health challenge especially for poor countries and continues to reverse the gains made in key sectors of these economies. However, although substantial progress has been made in the provision of health care services for people living with HIV/AIDS including free ARVs, enormous gaps still exist. And for every person placed on treatment, two to three are newly infected. Globally, in 2007 alone there were 2.7 million new infections and only 31% of those who needed treatment received it. And while all currently available anti-HIV drugs suppress the virus, they cannot eliminate it. Furthermore, conventional anti-HIV therapy is a lifelong commitment, accompanied by many life altering and some potentially life threatening side effects.
    Indeed, there is a pervasive myth that the answer to the HIV/AIDS challenge is availing conventional ARV’s. But while such programmes are absolutely necessary in times of crisis, they are less a component of adequate control model than an indication of its failure.
    Furthermore, the current ARV’s procurement system has been shown not to be sustainable. Global scramble for ARVs as HIV in Asia and Eastern Europe rise and put pressure on production capacity, and “only nations that are pursuing self sufficiency in ARV’s production will assure their people of an uninterrupted supply and treatment”
    Indeed, we have a strategic choice to make; we can decide to ignore traditional medicinal resources and concentrate on availing ARVs and convectional drugs alone-with their side effects and create an enormous economic, social, and health loss.

    Alternatively, poor communities can be assisted to adopt locally available cost effective medicinal resources whose validity and efficacy have been tested by communities for eons and sufficiently fight a growing cocktail of diseases in part due to proliferation of HIV/AIDS. Dealing with HIV/AIDS scourge without a reliable supply of drugs will be extremely complex, involve literally billions of dollars which poor countries cannot afford if we are going to rely exclusively on global level interventions with conventional drugs and ARV’s. However, we can sustainably meet these demands if evidence-based Traditional Medicinal Resources increasingly become tools of choice for these campaigns during the coming decades. The availability of alternative options is critical to the success of the war on HIV/AIDS globally, particularly for poor communities
    Indeed, to effectively combat HIV/AIDS we must be ready to use diverse non- conventional methods like Traditional Medicinal Resources TMR, in particular, in bridging these health gaps. The opportunity here would be to orient HIV/AIDS control with these resources and policy to expand access to health care services with strategies that are evidence based. A crucial gap in the war on HIV/AIDS has been lack of accelerated research and development of new products from Traditional Medicinal Resources which holds promise for other options.
    Enormous benefits can be realized by availing these resources to enhance ability of health systems in more HIV/AIDS and poverty ravaged regions and communities to manage HIV/AIDS sustainably.
    The decades-old-ways- in which those keeping watch over AIDS have relied less on local resources and more on faith in donors to fund the HIV/AIDS programme- and which have been less than successful-must be put into question. The signs from the recent global economic crisis and the adverse economic and ecological effects of climate change are also not terribly encouraging. Therefore, anything less than a new departure from this may not be tenable.
    we must think beyond desperate, firefighting tactics that only assuage the suffering of the moment (and not for everybody eligible for assistance) to tangible and enduring solutions. Indeed, significant progress can be realized in the war against HIV/AIDS if we have the courage and single-mindedness to support non-conventional initiatives that have been shown to work like grain amaranth based nutraceuticals. Moreover, amaranth is a symbol of African indigenous culture and this is perhaps why in nearly all Kenyan communities, for instance, it has a local name.

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