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AIDS Funding Grows, But Insufficient to Global Crisis
Background Information for a Reporter’s Notebook, Part II of a Series
July 1 - Next week, more than 15,000 participants will gather in Barcelona, Spain for the 14th International AIDS Conference, which runs July 7-12, 2002. Convened by the International AIDS Society (IAS), a professional society for scientists, health care, public health workers and other engaged in HIV/AIDS prevention, control and care, the meeting has emerged as one of the most important annual public health gatherings.
PLANetWIRE’s features are intended to inform reporters and others interested in focusing on some of the most profound issues shaping and/or surrounding the epidemic, some of which have received less than deserved attention in the media.
Features include:
The HIV/AIDS crisis has emerged as the greatest public health challenge in all of human history. There are 40 million people infected with the HIV/AIDS virus today and more than 20 million people have already died from the disease. Last year, 5 million people were newly infected. The disease has also spread geographically and now impacts all regions of the globe, including some of the world’s poorest countries. Especially hard hit are the low-income countries of sub-Saharan Africa. As the epidemic has grown, so have the resource requirements for comprehensive HIV/AIDS prevention, treatment, care and research programs.
CURRENT SPENDING ON HIV/AIDS
According to UNAIDS, the most recent data indicate that in 2000, HIV/AIDS spending from all sources in low and middle-income countries totaled $1.8 billion, of which $1 billion was spent on HIV/AIDS treatment and care (including an estimated $500 million expended by people living with AIDS), and $800 million spent on prevention of HIV/AIDS infection.
The poorest regions of the world are especially dependent on development assistance in order to mount effective HIV/AIDS prevention, treatment and care programs. In the early stages of the epidemic, the vast majority of assistance provided by donors was channeled through multilateral organizations, including the World Bank, which has provided more than $1 billion in concessional loans to support HIV/AIDS programs in developing countries.. As international funding has increased, however, most resources have been redirected through bilateral assistance programs, which now account for 80% of all international assistance.
ESTIMATED FUTURE RESOURCE REQUIREMENTS
During the preparations for the 2001 UN Special Session on HIV/AIDS, experts estimated that a five-fold increase would be needed by 2005 and thereafter in order to reverse the spread of the disease in low and middle-income countries. According to the estimates, $3.2 billion will be needed in 2002; $4.7 billion in 2003; $6.8 billion in 2004; and $9.2 billion in 2005. Of these total resources, 35-50% are expected to come from the low and middle income countries themselves, the balance will be needed from international donors.
The $9.2 billion estimated need for 2005 would include $4.8 billion to support an array of HIV/AIDS prevention activities (including the provision of condoms, treatment of sexually transmitted diseases, prevention of mother-to-child-transmission, and blood screening) and $4.4 billion for treatment and care programs (including provision of anti-retroviral drug therapies, treatment of opportunistic infections and care and assistance for children orphaned by AIDS).
THE GLOBAL FUND FOR HIV/AIDS, TB and MALARIA
In order to stimulate and encourage increased contributions from international donors to help meet the resource needs of low and middle income countries fighting the spread of HIV/AIDS, the UN Secretary-General, Kofi Annan, called for the creation in 2001 of a Global Fund for HIV/AIDS, TB and Malaria
(tuberculosis and malaria are closely associated with AIDS complications and prevention programs have powerful complementarities). The Secretary-General donated $100,000 of his own money to demonstrate his commitment to the Fund. To date, more than $2 billion has been pledged to the fund, the overwhelming majority of it by donor governments. Reflecting the growing contribution of philanthropic entities to international health efforts and AIDS prevention programs, the Bill and Melinda Gates Foundation contributed $100 million to the Fund.
The Fund was organized expeditiously and the first round of grants were announced this Spring. More than $600 million was awarded to HIV/AIDS prevention and treatment programs in more than 40 countries. For more information about the first round of grants, click here.
US SUPPORT FOR INTERNATIONAL HIV/AIDS PREVENTION PROGRAMS
As the world’s largest economy and leading provider of official development assistance, the United States is expected to play a major leadership role in terms of support for international HIV/AIDS efforts. According to recent estimates, the United States spends as much as $20 billion annually (public and private resources combined) to combat the HIV/AIDS crisis domestically. In fiscal year that ends September 30, 2002, the United States is expected to allocate $810 million to international AIDS programs, including $200 million for the Global Fund. President Bush’s fiscal 2003 budget proposal requested almost $900 million for international AIDS efforts, and subsequently he has requested an additional $300 million to support a new effort to prevent mother-to-child-transmission.
Efforts are underway in the US Senate, led by Senators Bill Frist, Jesse Helms and John Kerry to substantially increase US support for international HIV/AIDS efforts. The bill encourages a doubling in US expenditures for international HIV/AIDS assistance. It authorizes $1 billion in 2003 and $1.2 billion in 2004 as the US contribution to the Global Fund for HIV/AIDS, TB and Malaria. The bill also allocates resources for bilateral assistance programs coordinated by USAID. S. 2525 authorizes $800 million in 2003 for these programs and $900 million in 2004. A portion of these funds ($20 million in 2003 and $24 million in 2004) would be spent on research on microbicides, gels that women can control and use to prevent infection from the virus.
Similarly, $100 million is set aside in 2003 (and $120 million in 2004) for the purpose of acquiring pharmaceuticals used in treatment for persons living with AIDS. Finally, the bill authorizes enhanced expenditures by the US for international efforts to prevent tuberculosis and malaria.
THE RESEARCH AGENDA
Not included in the resource estimates described above is any reference to the substantial research agenda on HIV/AIDS vaccines and other medical breakthroughs that could help reduce the impact of the epidemic. That will be the subject of our next issue focus.
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