Global AIDS Funding Dries Up, With Tragic Consequences

Don McNeil has a thoroughly depressing story today in The New York Times about funding for global AIDS treatment drying up, with tragic consequences: people in Uganda and other African countries placed on long waiting lists for antiretroviral medicines that could treat them. In many cases, that's the equivalent of a death sentence. From Kampala, McNeil writes:

Uganda is the first country where major clinics routinely turn people away, but it will not be the last. In Kenya next door, grants to keep 200,000 on drugs will expire soon. An American-run program in Mozambique has been told to stop opening clinics. There have been drug shortages in Nigeria and Swaziland. Tanzania and Botswana are trimming treatment slots, according to a report by the medical charity Doctors Without Borders.

The collapse was set off by the global recession’s effect on donors, and by a growing sense that more lives would be saved by fighting other, cheaper diseases. Even as the number of people infected by AIDS grows by a million a year, money for treatment has stopped growing.

Other forces made failure almost inevitable.

Science has produced no magic bullet — no cure, no vaccine, no widely accepted female condom. Every proposal for controlling the epidemic with current tools — like circumcising every man in the third world, giving a daily prophylactic pill to everyone contemplating sex or testing billions of people and treating all the estimated 33 million who would test positive — is wildly impractical.

And, most devastating of all, old-fashioned prevention has flopped. Too few people, particularly in Africa, are using the “ABC” approach pioneered here in Uganda: abstain, be faithful, use condoms.

Coincidentally, I ran into Paul Farmer — the heroic infectious disease doctor and global human rights advocate — at a Brookline Starbucks this morning. He was bemoaning the NYT piece, frustrated after years of writing, speaking and pleading with anyone who would listen that the way to create better health for the world's poor is to integrate care and treatment, in this case AIDS treatment, and use that momentum to strengthen primary health care systems. To disassociate care from treatment, he has said, is a recipe for failure, and to not use funding for AIDS care as a way to boost the entire basic health system of a community is an opportunity lost.

Dr. Farmer gave me a copy of his new book, Partner To The Poor (University of California Press, 2010) and told me to read an essay called, "Integrated HIV Prevention and Care Strengthens Primary Health Care: Lessons From Haiti." Perhaps the world donor community, fatigued and maxxed out, should do the same.