Facing a growing deficit and political demands to cut spending, the Obama administration is planning to scale back U.S. support of global AIDS programs and pushing to unload some of the burden on other countries.
It’s a shift that comes at exactly the wrong time in the 30-year fight against the virus, AIDS activists say.
Over the last two years, scientists have found that a daily pill, Gilead Sciences Inc.’s Truvada, can reduce the risk of healthy people getting HIV by as much as 94 percent, and that early treatment can stop those infected from spreading the virus.
What’s lacking is the money needed to convert that knowledge into an endgame attack on the epidemic, said Chris Collins, a vice president at amfAR, the Foundation for AIDS Research. His point, echoed by the World Health Organization among others, promises to be a central debate at the first International AIDS Conference to be held on U.S. soil in 22 years, starting today in Washington.
“We are at risk of not following through on one of the great global health opportunities of our generation,” Collins said by telephone. “Either we make more investment now, and really begin to see the end of this, or we don’t do that and see this epidemic go on for generations.”
There are a record 34.2 million people worldwide living with HIV and the virus killed more than 4,000 people a day last year, according to the World Health Organization. In South Africa alone, a country where almost 1 in 3 people live on less than $2 a day, 18 percent of those ages 15 to 49 are infected, the data shows.
The AIDS meeting, to be attended by more than 20,000 activists and researchers, comes at an awkward time for President Barack Obama, who will give a welcoming address to the conference attendees today via video.
Former President George W. Bush, a Republican, more than tripled U.S. funding for global treatment during the last five years of his administration through the President’s Emergency Plan for Aids Relief, or PEPFAR. With that increase, U.S. funding covered about 59 percent of all donations for global AIDS relief, according to Jennifer Kates, director of global health and HIV policy for the nonprofit Kaiser Family Foundation, of Menlo Park, California.
In 2010, the year after Obama took office, the PEPFAR budget was $6.9 billion, including money to combat tuberculosis, the leading killer of AIDS patients. Next year, the funding will fall to $6.4 billion, if Obama’s proposed budget is enacted. The administration believes other countries need to step up and help carry the financial load in the future, according to Eric Goosby, Obama’s Global AIDS Coordinator.
“The United States can’t be ministries of health for all of these countries,” Goosby said in a telephone interview. “Our best chance at not having the United States be the predominant resource motor for HIV treatment and HIV/TB treatment on the planet is to bring others to the table to put their resources to it.”
Goosby said he didn’t expect to face financial constraints for global AIDS when he joined the Obama administration in June 2009, and he’s had to spend time lobbying members of Congress who control appropriations to sustain support for the program.
“I was really startled to hear that the negotiation around the resources was not only serious but severe,” he said at an event yesterday hosted by the nonprofit Center for Strategic and International Studies in Washington.
Members of Congress elected in 2010, when Republicans took over the House of Representatives, “not only did not know what PEPFAR was, they did not have a perception of what the AIDS epidemic was on the planet, much less in sub-Saharan Africa.”
Even with diminished funding, the U.S. can increase the number of people treated going forward because much of the spending on infrastructure, including clinic construction and the training of health-care workers, is done, he said. Additionally about 98 percent of drugs used now are cheaper generics, according to Goosby.
The average cost of a year’s supply of drugs has fallen to $100 a person in the lowest income countries from $10,000 a year in 2000, according to data from the WHO.
Still, the funding cuts are being questioned, even by some in the president’s own Democratic Party, at a time of extraordinary scientific progress against the disease.
“We cannot walk away thinking we’ve done our part and it’s on them now if we are serious about our goal of an AIDS-free generation,” said Congressman James McDermott, a Democrat from Washington, during a July 10 forum on the PEPFAR funding.
AIDS activists do agree that more countries need to contribute, and are urging China and Russia to make significant contributions, said Mitchell Warren, executive director of the nonprofit group AVAC: Global Advocacy for AIDS Prevention. Still, it’s not the time for the U.S. to cut back when major progress against the epidemic may be possible, he said.
Over the past two years, researchers have determined that the drug Truvada, a staple of treatment for those infected with HIV, dramatically trims the risk of healthy people becoming infected when taken daily. And last year, a study found that giving people treatment as soon as they are diagnosed, rather than waiting until their immune system is weakened, can reduce transmission of the virus by 96 percent.
As a result, the World Health Organization last week said its goal was to see AIDS treatment expanded to 23 million people from the 7 million who get therapy now, according to Gottfried Hirnschall, director of the WHO’s AIDS department.
The expansion would include those newly diagnosed, couples where one person is infected, pregnant women and groups at high risk of becoming infected, including men who have sex with men. While such a move would probably cost about $28 billion, or $11 billion more than the $17 billion spent last year, it could save 800,000 lives, Hirnschall said in an interview.
“We will have to do everything to increase donor funding while also further encouraging countries, specifically the middle income countries, to use their own resources,” he said. “Investment in early treatment makes sense both from an economic as well as public health perspective.”
In Africa, the funding cuts over the past two years are already being felt, according to Teguest Guerma, director general of the African Medical and Research Foundation.
Guerma, whose group is the largest African-based non- government health organization, said some already infected patients have lost access to the free drugs they were getting through the U.S. program, and there’s little chance of ready access to Truvada for uninfected people at high-risk of contracting the virus, such as sex workers and truck drivers.
While AIDS medications can cost as little as $8 a month in some countries, that’s still out of reach for many in Africa who live on less than $1 a day, according to Guerma, whose headquarters are in Nairobi, Kenya.
African countries have been increasing funding to meet the demand, she said, with low and middle income countries spending about 15 percent more on domestic HIV programs last year, for a total of about $8.6 billion. Still, it’s not enough, she said.
“Money is getting lower and lower,” Guerma said. “But the need is still there.”