by Mark Hines
The global economy has experienced a deep recession. In the United States, we have seen signs of an improving economy, but unemployment numbers continue to rise. With money such a scarce resource, difficult decisions need to be made about our priorities and where to spend our dollars. Funding the fight against HIV/AIDS must remain both a domestic and international priority for the simple reason that people are dying every day from AIDS. Put simply, a cut in funding contributes to continuing this devastating trend.
After over twenty years of work battling HIV/AIDS, is the funding community beginning to suffer from AIDS fatigue? Some in the global health community argue that a disproportionate amount of money goes to fighting HIV. However, the HIV/AIDS pandemic continues to ravage parts of the world, particularly in sub-Saharan Africa. According to statistics compiled by the Global AIDS Alliance, there are an estimated 33 million people living with HIV, 66% of whom live in sub-Saharan Africa. It is not that an excessive amount of money is funneled into HIV prevention and treatment; in fact, not enough money is allocated to public health across the board.
Despite promises to increase funding that President Obama made during his campaign, funding from the United States toward fighting HIV/AIDS has flat-lined (Brulliard 2009). The US government contributes bilaterally through the President’s Emergency Plan for HIV/AIDS Relief (PEPFAR) and multilaterally through the Global Fund to Fight AIDS, Tuberculosis, and Malaria.
Citing the economic recession, the Administration has halted increases to funding PEPFAR, and the US Global AIDS Coordinator, Ambassador Eric Goosby, has warned that we should not expect the past increases that were seen in PEPFAR to continue. The Global Fund, which has already been forced to cut approved grants, will continue to face funding problems as the Federal Government of the United States is one of its largest donors.
With financial pressures a stark reality, HIV/AIDS advocates must search for high impact strategies that will stretch allocated dollars further. Three methods of fighting HIV/AIDS that have broad appeal and high impact are prevention of mother to child transmission, ending gender based violence, and providing free basic education. These strategies could prove most effective in harnessing those scarce development and humanitarian dollars.
Prevention of Mother to Child Transmission
The United Nations Millennium Development Goals included improving maternal health and declining child mortality. The prevention of mother to child transmission (PMTCT) has become a key strategy to preventing a great number of new infections each year, and it is an approach that should receive broad support from multiple aid communities for its impact on maternal and child health. PMTCT also contributes to the global goal of achieving universal access to treatment, which has been defined by the UN as 80% coverage in providing antiretroviral treatment for those living with HIV/AIDS.
Both PEPFAR and the Global Fund have cited PMTCT as high priority initiatives for funding. Carla Bruni-Sarkozy, the First Lady of France and ambassador on behalf of the Global Fund, called on leaders to eliminate mother to child transmission at an event in New York City in September 2009. NGOs, such as the Global AIDS Alliance, have also targeted PMTCT. Global AIDS Alliance launched its Campaign to End Pediatric HIV/AIDS in Johannesburg, South Africa, in October 2009. PMTCT has broad support from the US government, other donor governments, leaders in sub-Saharan Africa, and civil society organizations. In order to be effective, this strategy requires access to drugs, a safe birth delivery environment and practices, and effective substitutes for breastfeeding.
It is most effective for the mother to be on antiretroviral drugs for a lifetime, and universal access to drug therapy should be a priority for mothers as well as children at birth and for lifetime if transmission of HIV occurs. However, the WHO has also made recommendations for effective PMTCT even in resource-limited settings. Currently, the most effective treatment includes a combination of AZT and single dose nevirapine at birth. While not as effective, a single dose of nevirapine during the onset of labor and after birth can lead to reductions in HIV transmission.
Ending Gender Based Violence
Women are disproportionately affected by the HIV/AIDS epidemic. In Africa, women compose approximately 60% of those who are infected. Many of the cultures in sub-Saharan Africa are male-dominated and patriarchal. Further, major conflicts in the area have seen gender-based and sexual violence used as a weapon of war that has become entrenched in societies even post-conflict. Rape is abundant, and the stigma associated prevents women from reporting violence and seeking treatment.
Addressing violence against women and girls is imperative in fighting HIV/AIDS. Traumatic sex has a higher incidence of spreading HIV and other sexually transmitted infections. Women who have been victims of violence are also less likely to request the use of condoms or other contraceptives. Women must have the ability to refuse sex, have access to contraceptives, and be able to obtain proper post-trauma treatment such as antiretroviral post-exposure prophylaxis
In order to affect sexual violence, a broad coalition must be formed to change the cultural conceptions about women in society. Men must be included in this effort as well as heads of state. The United States is considering taking action in tying foreign assistance dollars to fighting gender-based violence. Congress may soon take up discussion on the issue with the impending introduction of the International Violence Against Women Act (I-VAWA). One organization pushing for the swift passage of I-VAWA, Amnesty International, argues that combating HIV/AIDS properly must include addressing women’s rights. Ending gender-based violence will reduce rape, allow women to more safely negotiate sex, and lower HIV infection rates.
Universal basic education is important to society’s economic productivity and general health. It is a good investment in the future, and it can have a large impact on reducing the number of new HIV infections each year. About 77 million children globally are currently not attending school due to lack of access. Further, young people between 15 and 24 comprise about 40% of new infections every year (Global AIDS Alliance).
Links have been shown between achieving a basic education and safer sex behavior in children. Including comprehensive sex education in the curriculum could prove even more successful. By funding education, we can equip young people with the information necessary to make good decisions about their own bodies and others. Young people who are in school are less likely to engage in sexual behavior. In fact, education leads to being more likely to delay sex, marry later, and use contraceptives such as condoms. Education will also lead to women’s empowerment and help to mediate gender-based violence.
Money to support education initiatives world-wide largely funnels through the Education for All – Fast Track Initiative run by the World Bank. Pressure should be placed on this mechanism for more effective funding since much of the money allocated to countries for education has not been disbursed. Further, during his campaign, President Obama pledged the creation of a Global Fund for Education, which would be an important step in universal basic education funding. It could be developed as a more effective tool than the Fast Track Initiative.
Finding the Political Will(
As a society, we have developed the methods for putting an end to the HIV/AIDS pandemic. We know how HIV is transmitted, and we know how to prevent its transmission. We have antiretroviral therapies to administer to those infected so that they may live a long and productive life. What we do not have is the political will to decide to put full funding into the fight to end HIV/AIDS. The initiatives mentioned here will have great impact and broad appeal, but what we must push for is full funding of programs. Anything less will lead to more unnecessary death.
Email Mark Hines at email@example.com