More sustained financing is needed to continue global progress against HIV/AIDS. Given the current challenges to global health financing, new solutions are vital to changing the current rate of progress.
“There is a moral obligation to maintain treatment for those who need it, and considerable resources have been implicitly pre-committed to lifelong HIV treatment and care,” say the authors of a recent paper published in the PLoS Medicine journal.
More money also needs to be better spent, they argue. HIV work must be linked to health systems strengthening, a move that will both increase the reach of HIV work and support the underlying health problems that contribute to the problem.
Financing the HIV response must also be achieved without damaging investments in health systems more broadly and other development sectors that are essential for social welfare (in turn addressing a number of the barriers to scaling up the HIV response). An HIV programme may have important external benefits for sexual and reproductive health; maternal and child health; or provide the necessary health system platforms for managing chronic conditions. Similarly, investments in strengthening health systems or addressing related co-morbidities that compound HIV vulnerability or worsen treatment outcomes are critically important to individuals living with HIV. Although core HIV interventions have been demonstrated to be cost-effective, total HIV spending in sub-Saharan African countries was an estimated 19.4% of total health spending in 2007 (range: 0.7%–64.4%). This amount exceeds the relative burden of HIV disability-adjusted life years and is at least partly due to the relatively high costs of HIV treatment compared to treatment for other prevalent diseases. There remains a difference between the amount spent on the HIV response across countries with a similar GDP per capita and HIV prevalence, and more work is required to understand the optimal level of domestic resourcing for HIV, given competing health sector priorities.
There are examples of innovative financing schemes, but they face challenges. The authors recognize that overtaxing and a hyper-focus on HIV/AIDS can do more harm than good. A careful approach that applies lessons learned can ensure changes are effective.
Innovative revenue streams are currently being explored in several countries. These schemes can generate significant funds, as seen in Zimbabwe with the 3% AIDS levy deducted from businesses and formal sector workers’ salaries since 2000 . Other options, such as increased “sin taxes” on alcohol, could generate a “double dividend” by simultaneously increasing revenues and decreasing HIV-related risk behaviours . The development of social health insurance could help attract further household resources and may be an important new source of financing in middle-income countries as development assistance scales down
By Dr. Anges Binagwaho, Minister of Health, Rwanda
The op-ed originally appeared in US News and World Report. It is based on an article she co-authored last week in the New England Journal of Medicine on the HRH program together with Paul Farmer, Eric Goosby and others. Available here.
Over the past decade, we have made extraordinary gains against the world’s deadliest diseases thanks to the U.S. President’s Emergency Plan for AIDS Relief and The Global Fund to Fight AIDS, Tuberculosis, and Malaria. These initiatives are saving millions of lives every year. In order to make these gains truly sustainable, we must now address a critical challenge in low-income countries: an acute shortage of highly-trained health professionals.
While Sub-Saharan Africa bears 24 percent of the global disease burden, it’s served by only 4 percent of the global health workforce. As the World Health Organization just announced, the global health worker shortage stands at more than 7.2 million today and is expected to grow to 12.9 million by 2035.
A report that my colleagues and I published in the “New England Journal of Medicine” offers compelling new evidence about the power of partnership in helping Rwanda, my country, to overcome this obstacle. The Human Resources for Health program – financed by PEPFAR and The Global Fund – is building health care worker capacity in Rwanda over the next seven years to ensure that we can meet the pressing health challenges facing our people.
We are making historic progress against HIV/AIDS: The global rate of new HIV infections has leveled, and the number of annualAIDS deaths has decreased by nearly a third since 2005. Antiretroviral drugs are driving these gains by stopping progression of the disease and, we now know, preventing the spread of HIV infections.
Yet AIDS remains the leading cause of death in sub-Saharan Africa, where poverty limits access to lifesaving treatments and 25 million people are living with HIV—representing 70 percentof cases worldwide. President Barack Obama should be commended for uniting the world behind the goal of creating an AIDS-free generation. I share his passion and believe we can achieve this in the next decade—but only if we accelerate the provision of antiretrovirals to the poorest and most vulnerable people.
The opportunity has never been clearer. New data published in the New England Journal of Medicine project that early treatment with antiretrovirals in South Africa, my home country, would prove very cost-effective over a lifetime (costing $590 per life-year saved) and generate both public health and economic benefits. The World Health Organization now recommends early and preventive treatment with antiretrovirals, including administration to children and uninfected partners of people living with the disease. The WHO estimates that this could save an additional 3 million lives and prevent at least as many new HIV infections through 2025.
On June 18th, 2013, PSI Caribbean and The Caribbean Broadcast Media Partnership on HIV/AIDS, launched a regional radio contest encouraging the Caribbean youth to submit songs that have messages to combat the HIV/AIDS infection and stigma across the reason.
The contest drew attention from the following countries: Antigua and Barbuda, Barbados, Dominican Republic, Jamaica, St.Vincent & the Grenadines, St. Lucia and Suriname with a total of 27 entries.
The winner? The Jamaica Youth Theater crew (see video above)
The Jamaica Youth Theatre is a group of talented young people ranging from the age of 13 to 20 years old. These youth are recruited from several secondary schools all over Jamaica, each with a burning passion for theatre. The Jamaican Youth Theatre was formed in 2004 as the performing arm of the Schools’ Drama Festival of Jamaica.
The Mitr Trust, an HIV drop-in center in New Delhi, India, is helping to deal with the problem of HIV by providing support to the most vulnerable: sex workers and LGBTs in the city.
It builds off evidence that targeted work against HIV/AIDS has helped to reduce the spread of the virus. Noam Levey reports for the LA Times that the projects number of HIV/AIDS positive people in India would reach around 25 million by today. In fact, there are only 2.4 million Indians currently with HIV/AIDS. The projects may have been overestimated, but falling so far below the number is a testament to efforts in the country over the past decade.
Reducing stigma and working with the people living on the margins of society will ensure that HIV/AIDS does not explode in India. Levey writes:
Some countries have granted rights to the lesbian, gay, bisexual and transgender community that go beyond those in the United States.
“This is the first disease where people affected demanded a seat at the table,” said Dr. Chris Beyrer, an epidemiologist who heads the Center for Public Health and Human Rights at Johns Hopkins University. “LGBT communities are literally emerging out of the HIV response.”
AIDS activists say the tipping point against AIDS will be when more people are on life-saving treatment for the first time than the number of new cases each year. The ONE Campaign calls the point the beginning of the end of AIDS. We are not there yet, but some countries are doing well. Unfortunately those lagging are mostly located in the Global South.
The NGO AVAC decided to analyze how countries are doing in their fight to end AIDS. There is some good news, but countries like Nigeria with its giant population, threaten to circumvent progress. The New York Times highlighted the findings writing:
“There’s all this talk about ending AIDS,” said Mitchell Warren, AVAC’s executive director. “We wanted to find a mechanism that could chart the progress over time, and use it as a management tool, and to make comparisons between countries that are doing the right things and the others.”
Dr. Luiz Loures, the deputy executive director of the U.N. HIV/AIDS agency (UNAIDS), said it is possible for the epidemic to be gone in 17 years.
The percentage of people infected with HIV/AIDS has dropped by one-third since 2001, UN officials said. The reported numbers of HIV infections dropped 33 percent in 2012, while new infections among children dropped 53 percent.
U.N. officials are prepared to provide treatment for 15 million people in low and middle income countries by 2015. According to UNAIDS reports, 10 million people from those countries are receiving life saving treatment.
However, the report also found that progress is slow in finding HIV services for people at most risk for contracting the disease. The epidemic is growing among men who have unprotected sex with men, sex workers and people who use intravenous drugs. Countries that promote the fear of disapproval of someone’s sexual orientation were also preventing people from getting help, they said. [emphasis added]
To defeat AIDS we need to target populations most vulnerable.
The Global Fund to Fight AIDS, Tuberculosis and Malaria released their mid-year results for 2013. The numbers are very exciting.
More than 5.3 million people living with HIV receive ARVs thanks to the Global Fund. The findings also observe a 21% increase in the number of women treated to prevent mother-to-child transmission of HIV.
“These results show that we can have a transformative effect on these diseases, by working together,” said Mark Dybul, Executive Director of the Global Fund. “More people affected by HIV today can go to work, send their children to school and lead healthy lives thanks to the hard work of all our partners.”
Big strides have also been made in the fight against malaria, with 30 million insecticide-treated nets distributed in the first half of 2013 under programs supported by the Global Fund, taking the total number of nets distributed to 340 million. The number of cases of malaria treated rose to 330 million, a 13 percent increase.
Global Fund-supported TB programs also continued to expand. Global Fund financing has cumulatively supported detection and treatment of 11 million smear-positive cases of TB, up from 9.7 million at the end of 2012. The number of people treated for multidrug-resistant TB grew to 88,000 from 69,000 through Global-Fund supported programs. The World Health Organization reported that 56,000 cases were enrolled in treatment of multidrug-resistant TB globally in 2011, of which Global Fund-supported programs accounted for about 22 percent. India drove the leap forward, accounting for about 60 percent of the increase at the end of 2012.
Dr. Ariel Pablos-Méndez, Assistant Administrator for Global Health at USAID, recently visited various health projects supported by USAID in Guatemala. The USAID|PlanFam project, supported by PSI/Guatemala was one of the stops.
USAID|PlanFam project organized three activities related to sexual and reproductive health where Dr. Pablos-Méndez had the chance to actively participate:
a) visit a family planning clinic at Chichicastenango Centro de Atención Permanente (CAP) to observe infrastructure improvements, biosecurity, and the experiences of health providers related to training and skills to deliver FP services,
b) visit a local FP user´s household to exchange positive experiences about the use of modern family planning methods and attendance to health services, and
c) visit a health fair targeted to 120 adolescents to promote delayed sexual debut and the prevention of unplanned pregnancies, in the public school Cantón Chugüexá I.
Treatment as prevention of the spread of HIV has some pretty solid evidence that it works, but that does not necessarily mean that people are rushing to take ARVs. New research argues for taking new approaches to the problem so that the live-saving ARVs can get into the hands of the people who need them.
“Research in HIV prevention needs to get out beyond its comfort zone and meet with the people who have very different ideas about what HIV means,” said Jim Pickett, the project director for Mapping Pathways, an international research and advocacy project, to IRIN.
“We talk a lot about the results of science and figuring out how to `make it make sense’ in local contexts. But science is itself a process that should involve communities from the very beginning,” Pickett said.
That local context means tailoring communications and treatments to different countries and communities. It is the same idea that drives PSI’s use of social franchising and marketing. Much like choosing what soda to buy, people are influenced by packaging, commercials, quality and their friends. That very same idea can be applied to public health and, in this case, increasing the availability and use of ARVs to prevent the spread of HIV and AIDS.
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