Pressures on AIDS Funding

Pressures on AIDS Funding

Armed with improved data, UNAIDS has substantially reduced its estimate of 2010 spending requirements to deliver country targets for universal access. Nevertheless, its figure of $25.1 billion remains formidable and must contend with a perfect storm of resistance.

There are already signs that the global economic recession will disrupt government budgets and donor resources for AIDS programmes. The wider squeeze on development aid will almost certainly bring to a head long-simmering grievances that AIDS funding has been disproportionate.

Many poor countries invest more in AIDS programmes than in the rest of their health services combined. The two million annual deaths caused by AIDS-related illness compare with ten million through hunger, five million due to unsafe water and one million from malaria.

The most recent plans published by PEPFAR and the Global Fund acknowledge that the narrow "vertical" world of AIDS-related intervention must shift towards "horizontal" development support for general public health facilities. Such moves will recognise the significance of HIV and AIDS in crucial MDG agendas such as food security and maternal mortality.

AIDS funding estimates may themselves be affected by new guidelines published by the World Health Organization which recommend that ART should commence much earlier. They advise a CD4 threshold of 350 rather than 200 in developing countries, estimating that this might add up to 5 million people to the treatment backlog.

A final pressure point is the inherent exponential profile of future demand for antiretroviral treatment. Growth will be driven by the goal of universal access, the continuing high rate of new infections and the longer life expectancy of patients.

The human consequences of any interruption to antiretroviral treatment add great complexity to economic considerations. A patient may develop resistance to the drugs if unable to sustain 95% adherence to the prescription, creating the need for more expensive second line treatments. This knowledge influences governments to prioritise treatment at the expense of prevention programmes, rekindling the embers of the epidemic.