$50 billion needed for global AIDS control

May 25 2008

As Congress considers the renewal of PEPFAR (the President's Emergency Plan for AIDS Relief), the successful US global AIDS program, over the coming weeks, AIDS Healthcare Foundation (AHF) President Michael Weinstein offers the following commentary regarding what is needed in the global fight against HIV/AIDS:

"A battle has begun to rage in Washington about how America should approach global AIDS. The good news is that virtually everyone believes that funding the global battle to combat the disease is a great idea. As is so often the case in Washington, the battle lines have been drawn in a fashion that produces more heat than light.

"There are three major issues that divide the protagonists: Should the bill focus on treatment with a requirement that the majority of the money be directed toward medical treatment with the goal of directly saving more lives, or on a variety of other concerns? Secondly: Is $50 billion too much money for the US to spend? Third: How should we approach prevention?

"The current bill requires that 55% of the funds be spent on treatment. This requirement has resulted in 2 million people receiving life-saving medical care. Millions of potential orphans have been averted. We are well on our way to a strategy for global AIDS control. The version that has already passed the House and the Senate Foreign Relations Committee has removed the 55% floor and despite raising the money from $15 billion to $50 billion - a 333% increase - the number of lives saved only goes up to three million or 50%.

"The proponents of saving fewer lives argue that there needs to be more 'flexibility.' What is meant by flexibility is unknown. However, very often in foreign aid programs such flexibility means corruption, bureaucratic waste and mission creep. At the end of the day, it is very hard to justify spending so much more money if many more lives are not going to be saved.

"The good news is that the cost of providing AIDS treatment is falling. The bad news is that many more people need treatment today than five years ago and even more will need it in the next five years. Some say we cannot treat our way out of AIDS. Unfortunately, for the people who are already infected, the other option is dying our way out of AIDS.

"The strategy that the US has adopted to deal with global AIDS has been successful. Creating the hope of treatment has not only saved millions of lives, it has given us a handle on AIDS. When people know they can get treatment they will be tested. When they know they are positive most will protect their partners. When they are positive and are being treated and their virus is low, they are rendered virtually non-infectious.

"There are some who argue for more focus on treatment but against authorizing $50 billion-this is a mistake. To put the nail in the coffin of this epidemic we will need to identify the overwhelming majority of people who are positive and don't know it, which will then identify ten million people who need treatment relatively quickly. At $500 per patient per year, this alone is $5 billion. Other countries must also contribute to this effort. However, most of their efforts have gone into prevention, care and support and other services. The scale-up of testing will also require at least a half a billion dollar a year commitment.

"The requirement that 55% of the $50 billion be spent on treatment should reassure fiscal conservatives that the money will be well spent. The 45% of $50 billion that will be spent on prevention and other services is enough money to address many other priorities.

"When it comes to prevention of HIV/AIDS there are many hot-button issues that intersect: religion and culture. The evidence has clearly demonstrated that no one approach is entirely successful. However, the battle to control AIDS should not get trapped in a spider web of social issues that are not directly relevant. Abstinence, particularly the delay of sexual debut, is very beneficial. Be Faithful, will work if the partners know their status beforehand and practice safer sex if they slip up, as humans do. Condoms are virtually foolproof for the prevention of HIV if they are used consistently.

"If we look at this whole matter dispassionately in terms of basic public health principles we cannot go wrong. $50 billion is needed to effectively bring AIDS under control. Since AIDS is a disease, the majority of the money must be spent on medical treatment. Proven prevention methods must be employed, regardless of religious customs or beliefs, to break the chain of infection.

"If all of these basic principles are upheld, a global AIDS bill will pass quickly and be effectively implemented. And we will enshrine a history-making legacy of life-saving hope for the world, courtesy of the American people."

http://www.aidshealth.org