AIDS awareness poster in Zambia
Are we spending too much on HIV?
Spending by rich countries on fighting HIV in the developing world has come under fire recently. Critics argue the money would be better used tackling other diseases. Are they right? Pressureworks investigates.
'In rich countries, HIV has become the crusade of the famous, fashionable and influential. In high prevalence countries, HIV affects the middle classes more than the poor, and is of more importance to them: middle class women do not die from pneumonia and malaria and middle class women do not die in childbirth.'
The quote above is from Dr Roger England in a British Medical Journal article earlier this year. But it's not as unusual as you might think – there are more than a few voices out there calling for a critical look at HIV spending.
Dr England – who works at the Health Systems workshop in Grenada – wasn’t advocating cuts in international spending on health: he was just arguing that a lot of the (very large) amount of money currently spent on HIV could be spent more effectively on other things.
The quote above is from Dr Roger England in a British Medical Journal article earlier this year. But it's not as unusual as you might think – there are more than a few voices out there calling for a critical look at HIV spending.
Dr England – who works at the Health Systems workshop in Grenada – wasn’t advocating cuts in international spending on health: he was just arguing that a lot of the (very large) amount of money currently spent on HIV could be spent more effectively on other things.
Value for money?
In terms of measurable improvements in people’s quality of life for each pound or dollar spent on health, he has a point. You can argue very strongly that when money is scarce, it’s a better idea to spend it on proven interventions like – for example – treated bednets to prevent malaria, the prevention of traffic injuries, and treatment of childhood illnesses. All of these provide a lot of bang for the buck, every time. HIV prevention is a lot harder to measure and a lot less spectacular when it happens.
Dr England also points out that if you compare the effect of HIV with its funding, there’s an imbalance. In southern Africa, for example, HIV was 17.6% of the disease burden in 2001, and yet in 2004, it received a massive 40% of all health aid. Clearly these numbers aren’t quite comfortable with one another.
The weight of opinion in international health circles is pretty solidly against this line of thinking, though: the UN is not only against cuts but says we need to spend US$38 billion more than we did on HIV between 2003 and 2007. Not only that, but the 'resource gap' – the gap between what’s needed to fix the problem and the amount of money we’re chucking at it – is growing. If it carries on like it is now, half of what's needed for 2007 won’t be met either.
This is certainly the line that’s been taken by Pressureworks – in the past, we’ve argued and campaigned for more spending by rich governments, especially the G8, on HIV. Part of our mission is to hold these governments to account for the promises they make, and the easiest way to do that is to monitor what they’re spending on it.
Of course, that’s not the whole picture: governments do other things than parcelling out the cash. They lobby and persuade other governments, for example – just like we asked the UK government to do while it held the recent presidency of the G8.
Dr England’s article doesn’t give a full picture.
He’s absolutely right that HIV has become a trendy cause for some in the rich world, and no doubt many who work in fighting HIV are, and have been, thankful for the publicity and increased funding that have come as a result of that. But just because an issue is the chosen issue of Elton John, it is not therefore immediately less relevant to poor people in Lesotho. HIV is absolutely not a class issue – it’s a disease currently infecting 40 million people. They’re not all rich. Quite the opposite.
Dr England also points out that if you compare the effect of HIV with its funding, there’s an imbalance. In southern Africa, for example, HIV was 17.6% of the disease burden in 2001, and yet in 2004, it received a massive 40% of all health aid. Clearly these numbers aren’t quite comfortable with one another.
The weight of opinion in international health circles is pretty solidly against this line of thinking, though: the UN is not only against cuts but says we need to spend US$38 billion more than we did on HIV between 2003 and 2007. Not only that, but the 'resource gap' – the gap between what’s needed to fix the problem and the amount of money we’re chucking at it – is growing. If it carries on like it is now, half of what's needed for 2007 won’t be met either.
This is certainly the line that’s been taken by Pressureworks – in the past, we’ve argued and campaigned for more spending by rich governments, especially the G8, on HIV. Part of our mission is to hold these governments to account for the promises they make, and the easiest way to do that is to monitor what they’re spending on it.
Of course, that’s not the whole picture: governments do other things than parcelling out the cash. They lobby and persuade other governments, for example – just like we asked the UK government to do while it held the recent presidency of the G8.
Dr England’s article doesn’t give a full picture.
He’s absolutely right that HIV has become a trendy cause for some in the rich world, and no doubt many who work in fighting HIV are, and have been, thankful for the publicity and increased funding that have come as a result of that. But just because an issue is the chosen issue of Elton John, it is not therefore immediately less relevant to poor people in Lesotho. HIV is absolutely not a class issue – it’s a disease currently infecting 40 million people. They’re not all rich. Quite the opposite.
Striking at the future
The stats are repeated so often they almost get boring. Which is a terrible thing to say about such shocking numbers. HIV has reduced life expectancy to less than 30 in some countries. It has a disproportionate effect on economies, too, because it kills the most productive people in any country – the young and active.
It can’t be separated from other illnesses, either, like Dr England implies it might. For example, he suggests spending money on TB treatment instead of HIV – more efficient, he reasons. Sure, good idea. But TB is the number one killer of people with HIV, and HIV’s effect on their immune systems is often the reason they get TB in the first place – certainly the reason they die as quickly as they do. The answer to this particular problem is to design more intelligent systems – combine TB and HIV testing, for instance. Or combine the treatment regimes available for both diseases – which are both often very complex schedules, involving taking several different pills at very precise times every day.
But perfect systems are hard to put in place in countries with no money, often affected by war or instability, or hosting populations that are mobile or displaced or unimaginably poor. There’s a lot that money could do a whole lot more efficiently in a perfect world.
For now, it’s probably better to stick with the advice of the UN. We just need to scrape together another forty billion dollars.
 Add to del.icio.us |  Digg this |  Incoming links |
 |
|
|
Terms & Conditions © Christian Aid 2007