JOHANNESBURG, 7 July 2011 (PlusNews) - National AIDS programmes are feeling the pinch as the international community and governments rethink their prioritization of AIDS over other infectious diseases. The withdrawal of support for the fight against HIV is gaining momentum and it is time to get angry, according to Francois Venter, head of the Southern Africa HIV Clinicians Society. He spoke to IRIN/PlusNews about debunking the five major claims fuelling the backlash against global HIV expenditure, drawing on work by University of Cape Town professor Nicoli Nattrass and long-time HIV activist Gregg Gonsalves.
Claim 1: AIDS spending is disproportionate to the disease burden
“People say AIDS shouldn’t be the priority. There are a whole lot of disaffected people who feel they lost out, so they might think it should go to… education, arms or whatever priority they feel is more important. We need to be harsh about this [claim] and say that we’re spending what we should be spending.
“We’ve actually spent so long underfunding health as a whole, and particularly HIV and tuberculosis, that we probably could be spending even more money now [on them].”
Claim 2: The rise in HIV/AIDS spending has been at the cost of health spending elsewhere
Nattrass and Gonsalves have noted that while the proportion of HIV spending in health budgets globally more than doubled between the early 1990s and 2005, health spending increased generally – a gain Venter said was largely due to the advocacy around HIV.
“We have increased the amount of money being spent on health largely due to the advocacy around AIDS by saying, ‘this is the right thing to do’,” he told IRIN/PlusNews at the recent South Africa AIDS conference.
“If you look at the ‘pie’ it’s much, much bigger than it was 10 years ago. It’s still not big enough but we need to acknowledge that [progress on HIV] is not at the expense of a whole range of other things.”
Claim 3: The AIDS response undermined health systems by creating the “biggest vertical programme in history”
“I think we need to honestly acknowledge the fact that other health programmes are not functioning. I acknowledge the fact that the AIDS programme has been vertical and needs to be [integrated]. I think that AIDS programmes have had minimal impact on other programmes. The challenge for us in the HIV world is going to be to repair the rest of the healthcare system; we’ve made some real strides forward in terms of improving it.”
About 70 percent of HIV patients on treatment in the developing world receive drugs funding at least in part by the Global Fund to Fight HIV, TB and Malaria but Nattrass and Gonsalves highlight that more than one-third of the Fund’s money has gone to strengthening health systems.
The authors note that while the AIDS response initially centred around treatment activism focused on antiretrovirals and the prevention of mother-to-child transmission, it increasingly moved to other illnesses including tuberculosis, sexually transmitted infections and cervical cancer.
Claim 4: The AIDS response has undermined health systems directly by attracting human resources out of the public health sector
While Nattrass and Gonsalves acknowledge this happened in some cases, they cite a review of studies that concludes that in most cases, the HIV response helped build better public health systems.
Claim 5: Prioritize HIV prevention and radically cut back on AIDS treatment
“This is the one that makes me the sickest and I cannot understand that in this day and age people have started arguing that we should take away drugs from sick people and turn them to [HIV] prevention,” Venter said.
“I don’t think anyone... would argue prevention is properly funded, or has enjoyed the support that everything else gets but to try and pretend that [prioritizing prevention over treatment] is something we can do without losing a lot of sleep over? It’s just rotten.”
Venter quoted Gonsalves, who recently wrote the following in response to the backlash against funding HIV: “So when people say, ‘oh we can’t afford to treat people with HIV. It’s becoming an entitlement,’ we need to reflect on this abject terror: ‘we have what it takes to keep you alive, but we won’t pay for it. Your family is going to watch you die.’
“That’s what it was like eight or nine years ago, that’s what it was like in the United States 15 years ago. We need to tell people when they turn around and say, ‘we just need to spend on prevention,’ that this is what they actually mean,” Venter added. “You’re going to take people [with HIV] and send them back to their families to die and that is not acceptable.”