PARIS – In a year that marks the half-way point to the deadline for ambitious goals to contain and then end the global health impacts of HIV, and when the latest data illustrate the payoff of focused and determined investments, a flat donor landscape has opened a stark view of an alternate reality.
Encompassed in the view are the missed opportunities of people undiagnosed and untreated, of new infections that could have been averted, and of deaths that could have been prevented. And then in the spring of this year, the view included a U-turn, in the form of a steep drop in HIV spending from the world’s leading global health funder, proposed in the Trump administration budget plan for the year to come.
On Monday here, leading advocates discussed the threat those cuts as well as continued flat funding would pose.
With global HIV funding now at 2010 levels while now supporting treatment access to nearly three times the number of people, efficiencies are exhausted, Greg Millett of amfAR, the Foundation for AIDS Research said. He cited an amfAR analysis of proposed spending cuts finding they would have significant impacts — in declining numbers of people enrolled in treatment, in new infections, and in deaths.
In addition to global health programming cuts, noted Christine Lubinski, Infectious Diseases Society of America vice president for global health, the Trump budget proposes deep cuts to biomedical research, including to areas that would greatly propel HIV control efforts.”We still have a significant research portfolio in front of us,” she added, “including for a vaccine, a cure, long-acting injectable treatment.”
Among the missions of IDSA (which produces this blog) she noted, is work to ensure that research innovations to control infectious diseases advance, and are put into practice.
Congressional appropriators’ rejection last month of the most radical of the proposed White House cuts to global health and research have made HIV response and research advocates “cautiously optimistic that we’ll hold the line,” she said, but added that policies, including the Trump administration’s expanded global gag rule, restricting money for reproductive health and family planning services, also will limit resources available to HIV research and responses.
And while flat funding and proposed cuts have been accompanied by expectations that more countries will fund and sustain their own HIV responses, Solange Baptiste of the International Treatment Preparedness Coalition said, that expectation comes in the context of increasing adoption of “test and treat,” or treatment for all guidelines, which aim overall to take the numbers of people living with HIV who are accessing treatment from the current 19 million to 30 million. And she noted, governments tend to estimate and plan spending targeting their citizens. “But,” Baptiste added, “What country has no migrants?”
Another resource remains insufficiently tapped, she said.
“Communities can and have been known to take care of their own. When you meaningfully invest in communities you can do more, better,” Those investments, she added, are “not about spraying us with money.” But they will take time, she said, and they must include paying the community members who have been mainstays of HIV responses for their work.
What would they tell the Trump administration? a questioner asked. IAS President Linda-Gail Bekker who chaired the session offered this: ‘We either move forward or we move back. There’s no static.”
Baptiste added that she would speak to a larger audience “When governments fail you, you should resist, and change them.”