Thoughts on the 2008 AIDS Conference and Science reports on Global HIV Funding

( From Mexico ppt on "Do poverty and income inequality drive HIV transmission in
sub-Saharan Africa?" at the "Challenges in Defining the Economic Impact of the Global fight against HIV" session: by Greener, R)

The 17th International AIDS Conference in Mexico City has come and gone and the question on everyone's mind is whether the conversations that took place will be followed by effective action soon or it will remain just that, conversations.

The HIV pandemic is a complicated problem that has plagued too many people for too long. That is why so much money is invested in tackling the problems and that is why many people get quite defensive (or passionate) about the best strategy to confront the issue. The common basic conundrum is to allocate the influx money either towards prevention or treatments. The obvious answer is both, but at what ratio. The other common object of discord is ( or was) how to go about prevention: reinforce abstinence or a massive condom distribution campaign. Again is answer is probably somewhere in between although the effectiveness of abstinence program is still to be determined.

A special issue of Science published in July 2008 dedicated to HIV/AIDS states in the article the "Great Funding Surge":
" Last year, the HIV war chest for these developing countries, including some money from their own budgets, totaled $10 billion, more than a 20-fold increase [from a decade ago] "

10 billion is a lot of money, especially for some of the poorer countries. This is when a humanitarian global disaster is in danger of becoming a lucrative business where everyone involved wants a piece of the pie.
Heck, I work for a research lab and we are also seeking funds to complete our project.
This is when you hear rumblings from citizens of some developing countries that AIDS has become such a fund-generating machine that it might not be in everyone's best interest to solve the issue once and for all.
This is proposition is evidently preposterous but it emphasizes the need for a more efficient way to combat the problem.
Our project here at the lab belongs to the field of treatment and monitoring. So one could expect that I would advocate for funding allocated in that field.
( source: science article "where have all the dollars gone ?")

However, given the displays of riches by biotech and pharmaceutical companies at the conference and given that $1 million invested in prevention saves the lives of 1,000 times more people than the same money invested in treatments, I can only support the argument that bulk of the funding ought to go first to prevention programs until we figure out a way to propose cheaper, more effective ways to treat people in countries mostly affected by HIV/AIDS.

I am not advocating against universal access to treatments for all HIV+ people nor am I denigrating efforts of projects (such as ours) to provide proper tools for treatments. Evidently, we cannot NOT try to treat people who have contracted HIV but the global community in the past 5 years might have been putting too much emphasis on providing therapeutics to all and neglected to support adequately efficient prevention programs. Despite the enormous and commendable amount of money invested in tackling HIV, the global resources are still limited and we ought to ask ourselves how to best spend the resources.
Jon Cohen, one of the main authors in the special issue wrote that Botswana is a striking example of how the focus on treatments, although effective, has taken away from prevention efforts.
Botswana health minister Phumaphi:
"we are not addressing the drivers of the epidemics," by which she primarily means heterosexual behaviors. She worries, too, that the success with ARVs has increased complacency about becoming infected.

Many plenary sessions at the conference discuss the best way to utilize funds and the debate were,in my opinion, productive and also seem to favor a renewed focus on effective prevention and integration of prevention in therapeutics efforts.
( different HIV subtypes worldwide via Science)

The reason for my argument for a stricter dispersement of funds is this scathing report from Uganda and the Global Fund partnership with the private sector initiative:
( via Uganda Confronts Curruption)

The sum total of the enormous catalogue of flaws, shortcomings, errors, mistakes, and hiccups enumerated and detailed in all the above … adds up to a humongous picture of grand managerial inefficiency and incompetence. … The great losers in this sordid story were the people of Uganda; the international donor community; and, particularly so, the new experiment in Global Fund Public-Private Sector partnership. Above all, the most poignant and pathetic losers were the millions of persons infected and affected by the three scourges of HIV/AIDS, TB and Malaria. These millions watched in pain and agony as their dire hopes were dashed to dust through the incompetence of the [money's] stewards, and the naked greed of the middlemen (the sub-recipients) of the Global funds.
--Final report, the Judicial Commission of Inquiry into Alleged Mismanagement of Global Fund to Fight AIDS, Tuberculosis, and Malaria in Uganda.

As the saying goes, bad misguided help is often worse than no help at all aka the road to hell is paved with good intentions.

-My post on Global Voices on marginalized groups in Africa (including Madagascar) at the conference.
- One of the best session at the conference presented an interesting study presented at the conference on the correlation (or lack thereof) between Income equality and HIV incidence by Greener, R of UNAIDS.

1 comment: