Experts Call for Rethinking AIDS Money

In the two decades since AIDS began sweeping the globe, it has often been labeled as the biggest threat to international health.

BY Matthew Van Atta

January 19 2008 12:00 AM ET

In the two
decades since AIDS began sweeping the globe, it has often
been labeled as the biggest threat to international
health.

But with revised
numbers downsizing the pandemic -- along with an
admission that AIDS peaked in the late 1990s -- some AIDS
experts are now wondering if it might be wise to shift
some of the billions of dollars of AIDS money to basic
health problems like clean water, family planning, or
diarrhea.

''If we look at
the data objectively, we are spending too much on AIDS,''
said Dr. Malcolm Potts, an AIDS expert at the University of
California, Berkeley, who once worked with prostitutes
on the front lines of the epidemic in Ghana.

Problems like
malnutrition, pneumonia, and malaria kill more children in
Africa than AIDS.

''We are
programmed to react quickly to small children with AIDS in
distress,'' Potts said. ''Unfortunately, we don't have that
same reaction when looking at statistics that tell us
what we should be spending on.''

The world invests
about $8 billion to $10 billion in AIDS every year,
more than 100 times what it spends on water projects in
developing countries. Yet more than 2 billion people
do not have access to adequate sanitation, and about 1
billion lack clean water.

In a recent
series in the journal The L
ancet, experts wrote that more than one third of
child deaths and 11% of the total disease burden worldwide
are due to mothers and children not getting enough to
eat -- or not getting enough nutritional food.

''We have a
system in public health where the loudest voice gets the
most money,'' said Dr. Richard Horton, editor of
The L
ancet. ''AIDS has grossly distorted our limited
budget.''

But some AIDS
experts argue that cutting back on fighting HIV would be
dangerous. ''We cannot let the pendulum swing back to a time
when we didn't spend a lot on AIDS,'' said Dr. Kevin
De Cock, director of the department of HIV/AIDS at the
World Health Organization. ''We now have millions of
people on treatment, and we can't just stop that.''

Still, De Cock
once worked on AIDS projects in Kenya, his office just
above a large slum. ''It did feel a bit peculiar to be
investing so much money into antiretrovirals while the
people there were dealing with huge problems like
water and sanitation,'' he said.

Part of the issue
is advocacy, from celebrity ambassadors to red ribbons.
''No one is beating the drum for basic health problems,''
said Daniel Halperin, an AIDS expert at Harvard
University's School of Public Health.

Aside from
southern Africa, most of the continent has relatively low
rates of HIV and much higher rates of easily treatable
diseases like diarrhea and respiratory illnesses. Yet
much of the money from the West, especially from the
United States, goes into AIDS.

Halperin recently
wrote a commentary in The New York Times on the
imbalance and said he was astounded by the response.
Most were positive, he said, with many AIDS experts agreeing
it was time to reexamine spending.

Most AIDS
officials say the solution is to boost the budget for all of
public health. ''Why does the public health budget have to
be so limited?'' asked Tom Coates, a professor of
global AIDS research at the University of California,
Los Angeles. ''Let's not drag AIDS care and prevention
down to the level of every other disease, but let's bring
everything else up to the level of AIDS.''

But that may be
wishful thinking. ''At the end of the day, there are
limits to how big the public health pie can be,'' Halperin
said.

Since the
discovery of antiretrovirals to fight HIV in the 1990s, AIDS
has virtually become a chronic, treatable disease in the
West. But the disease has not been conquered so easily
in Africa. Not only are the AIDS drugs too expensive
for most patients, but major problems in the health
system need to be fixed first.

''It's hard to
get Western donors to listen,'' said Dr. Richard Wamai, a
Kenyan doctor at Harvard's School of Public Health.

Wamai said that
some African health systems are so weak, they cannot
absorb the donations, and AIDS drugs are sometimes left in
warehouses because governments cannot distribute them.

"Trying to
redirect AIDS money will take a long time,'' Wamai said.
''It's a bit like trying to stop an ocean liner.'' (AP)

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