Thursday, May 13, 2010

Bad News for the Fight Against HIV/AIDS

The New York Times published an article on Sunday about the virtual freeze on US funding for some government HIV/AIDS programs, such as in Uganda (and you can also see the Boston Globe article, published in early April, about it here). Unsurprisingly, the donor environment has been tight-fisted following the economic recession. Medical interventions for HIV/AIDS are incredibly successful--antiretroviral drugs (ARVs) are nothing short of a miracle--but they're expensive, and promoting adherence to complicated regimens, even without stigma, is not easy (Shameless plug alert: That's part of what makes m2m great, since we promote behavior change and empowerment by using mothers living with HIV as role models). But if patients living with HIV can't get drugs, which sounds like it's going to be increasingly more frequent as the US government and other donors continue to cut or freeze funding, they can't stay healthy. This will cause further illness, death, and a greater number of drug-resistant cases of HIV, as patients cannot access the ARVs they are supposed to take for life.

What's sad in this situation is that in shifting away from HIV/AIDS to maternal and infant health, the Obama Administration and others (such as the Gates Foundation) are actually hurting their own initiatives. Without prevention-of-mother-to-child transmission (PMTCT) drugs and programs, pregnant women are at a much higher risk--up to 30% (as opposed to less than 2% with PMTCT interventions)--of transmitting HIV to their infants. Furthermore, pregnant women who are HIV-positive are at a much higher risk for complications and death in pregnancy and childbirth, and ARVs can help mitigate this risk. And finally, if HIV-positive new mothers die of HIV/AIDS related-illnesses or are too sick to work or to care for their babies, then an even larger number of AIDS orphans and vulnerable children will surface and a larger number of babies will die.

There's no doubt that it's a complex issue. The allegations of corruption by Ugandan officials and a refusal by Uganda to invest enough in their own health infrastructure in the NYT article further contribute to the notion of "Dead Aid" (see Dambisa Moyo), on which I'm still undecided. Furthermore, what this kind of freeze communicates, to some extent, is that the lives of people living with HIV/AIDS are not worth saving--they're sick and expendable--and the treatments that can save them and help them be productive and healthy members of society aren't worth it. Don't try to tell me that's not wrong.

A recent Doctors Without Borders (MSF) report best sums up the situation with a quotation from Olesi Ellemani Pasulani, an MSF clinical officer at a hospital in Malawi:

"It is important to continue with ART and increase it even more. How can you go back to rationing access to care? It is a right to life. If treatment is threatened it will mean we go back to a situation worse than before ART [when HIV was a "death sentence" and many did not get HIV tests because there was no medical solution]. It will also damage the relationship of trust that communities have built with healthcare workers over the years."

Of course donors should be focusing on maternal and infant health--I saw enough in my nine months in Sierra Leone to confirm that. But HIV/AIDS issues should not suffer in the name of maternal and infant health--it's all connected. We need to be increasing our foreign aid for health, especially when people are suffering in the wake of the recession. All-in-all, cutting or freezing funding for HIV/AIDS is going to create ripples beyond the 33 million people living with HIV/AIDS in the world. It will also affect their children, families, friends, communities, and countries. Now more than ever (to quote the title of a recent WHO report), we should be funding health for men, women, and children in every part of the world.