World News

Compiled by Martin Flynn

HIV funding backlash begins

Three stories have dominated the international media attention on HIV this spring and all allege that billions of dollars spent on prevention and treatments is being wasted.

And it is no coincidence that these attacks on funding for HIV have coincided with a dramatic economic downturn across
the world.

Writing in the British Medical Journal (BMJ) this May, Roger England, chairman of the Grenada-based think tank Health Systems Workshop, said the writing is on the wall for UNAIDS and called for it to be shut down as it was distorting worldwide health financing.

He said that although HIV causes 3.7 per cent of deaths globally, it receives 25 per cent of health aid.

Money could be better spent on improving health systems within developing countries, England argues.

The creation of UNAIDS, the joint UN programme on HIV and AIDS, was justified because HIV was seen as exceptional, England writes, and the experiences of gay men meant that HIV was seen as a special case that demands confidentiality, informed consent and discourages routine HIV testing and tracing of sexual contacts.
But the exceptionalism argument grew, England says, to encompass HIV as a disease of poverty and an emergency requiring special measures.

“With its own UN agency, HIV has been treated like an economic sector rather than a disease.”

Accusing UNAIDS of using sensationalist language to justify costly spending on HIV, England argued that HIV is a major disease not a global catastrophe.

“Only 10 per cent of the $9 billion a year dedicated to fighting HIV is needed for the free treatment programme for the two million people taking these treatments. Most of the rest funds ineffective treatment outside the health sector.”

“It is no longer heresy to point out that far too much is spent on HIV relative to other needs and that this is damaging health systems.”

The global HIV industry is too big and out of control, England writes, and he concludes by calling for the switching of £10 billion annually away from HIV to support general health budgets instead.

And a second article, published in the journal Science, calls for a dramatic shift in HIV funding priorities and argues that much of HIV prevention money is being wasted on strategies which have little impact.

The researchers from Harvard University argue that investment in condom promotion, HIV testing and vaccine research has had limited success in Africa.

Instead they say that male circumcision and reducing multiple sexual partners should be the “cornerstone” of HIV prevention.
Studies have shown that condom promotion doesn’t work and HIV testing does not reduce risky sexual behaviour, the Harvard scientists argue.

“Despite large investments in AIDS prevention for some years now, it’s clear that we need to do a better job of reducing the rate of new HIV infections,” Dr Daniel Halperin said: “We need a fairly dramatic shift in priorities, not just a minor tweaking.”

A third argument, voiced by HIV epidemiologist Elizabeth Pisani in her new book ‘The Wisdom of Whores’, says that western governments are spending ’mind boggling’ sums treating HIV but would save more by concentrating on prevention.

“Today the AIDS industry has effectively won the lottery,” Pisani told the Guardian newspaper. “HIV is mostly about people doing stupid things in the pursuit of pleasure or money. We’re just not allowed to say so.”

“The AIDS industry has become an island unto itself.”

Responding to the criticism of UNAIDS, Paul De Lay said HIV was and is an emergency requiring an unprecedented response.

“Even the best health systems in the world cannot tackle AIDS alone. AIDS funding can and does bolster health systems more widely, providing wins for both AIDS and general health.”

Dr Robert Gallo, who along with Dr Luc Montagnier first identified HIV as the cause of AIDS, said there was a worrying tendency to sideline AIDS as a manageable disease.

“The 2004 Indian tsunami made great headlines, 200,000 died in one month. But every month there’s an AIDS tsunami – 200,000 people die each month from AIDS. Do you think it gets the attention
it deserves?”