Study finds HIV/AIDS funding does not undermine health care services for other diseases

May 3, 2012

While the battle against HIV/AIDS attracts more donor funding globally than all other diseases combined, it has not diverted attention from fighting unrelated afflictions -- such as malaria, measles and malnutrition -- and may be improving health services overall in targeted countries, according to a study on Rwanda published today in the May 2012 edition of the American Journal of Tropical Medicine and Hygiene.

A six-year investigation of health clinics in Rwanda by researchers at Brandeis University infuses fresh evidence into a long-standing debate about whether the intensive focus on HIV/AIDS, which in 2010 alone killed 1.8 million people, is undermining other health services, particularly in that are at the epicenter of the . For example, between 2002 and 2006, one-third of funds from wealthy countries earmarked for health and population programs abroad were committed to fighting HIV/AIDS.

"We found that when in Rwanda expanded AIDS services, these efforts had no adverse effects on other types of health care," said Donald S. Shepard, PhD, a professor at Brandeis' Schneider Institute for and the study's lead author. "There is even evidence that clinics that have received funding for HIV/AIDS services provide better care for all patients, including superior prevention services, than do clinics without AIDS programs."

Shepard and his colleagues note that their study differs from past efforts to analyze the issue because their investigation focused on the actual performance of health centers rather than on "inputs" such as overall spending on facilities or staff. For example, for the Rwanda study, the researchers collected data on the number of vaccines administered, visits for child growth monitoring, and non-HIV/AIDS hospitalizations.

They concluded that "for most indicators examined, there were neither prominent diversions nor enhancement effects" after AIDS services were inaugurated in the health centers. However, there was evidence that the health centers that offered AIDS services provided better preventive care than those that did not, including superior delivery of childhood vaccinations.

For several years advocates for childhood immunization, tuberculosis control and those seeking a general improvement in health services in poor countries have expressed concern that HIV/AIDS prevention and care activities are crowding out other deserving public health programs. Meanwhile, on the opposite side are advocates who argue that the sharp increase in HIV/AIDS funding is a rising tide that lifts all boats, bringing improvements in such areas as laboratories, disease surveillance, human resources, and information systems that generate broad benefits across the health care system.

The authors noted that this study was designed to answer concerns, such as in the Bulletin of the World Health Organization in 2006 about HIV funding "crowding out resources," for the many other health issues in the world's poorest people. The debate has become more heated since 2008 when the economic crisis squeezed public spending in industrialized countries, thus intensifying competition for international aid among a number of worthy causes.

Shepard and his colleagues, including researchers from the public policy consulting firm Abt Associates, explored the issue by comparing the state of treatment and prevention services at 25 rural health centers in Rwanda that launched comprehensive HIV/AIDS interventions between 2002 and 2006 to 25 centers that did not engage in these activities.

They noted that Rwanda is a particularly good location to consider the impact of HIV/AIDS funding on health services because the country has received a substantial investment from international donors to address the disease, and its experience has been used to support both sides of the debate regarding the impact of AIDS spending. In 1996, the HIV infection rate in Rwanda was 6.9 percent among the rural population; the latest data show a 2.3 percent prevalence of disease in rural populations and 95 percent coverage of anti-retroviral treatment.

"Rwanda's progress against HIV/AIDS has not come at the expense of addressing other health needs," Shepard added. "While the differences between the health centers was not large, we did find indications that the AIDS funding may be having spill-over effect in terms of improving overall quality of care," Shepard said. For example, Shepard and his colleagues speculate that by simultaneously providing AIDS services along with a variety of other family health care interventions, the clinics that offer AIDS treatment may have more encounters with children who would otherwise miss their vaccinations.

The researchers were not able to measure other ways in which the AIDS funding could have benefited health services overall by, for example, streamlining drug procurement or improving information systems. They also acknowledge that the central finding—that the AIDS funding did not have a negative effect on non-AIDS health services—could be attributed to the fact that Rwanda has done an exceptional job of integrating AIDS services into the national health system.

However, they note that the experience in Rwanda adds to a growing body of evidence from several countries that AIDS-related funding is not adversely affecting non-AIDS services. For example, a study from Ethiopia found that while the increase in AIDS funding might have encouraged health professionals from the public sector to take positions with non-governmental organizations, mortality rates nationwide nonetheless dropped, immunization rates increased, and pre-natal care improved.

"What is at the heart of this research is that the science community is unified by its commitment to improved health for all," said James W. Kazura, MD, President of the American Society of Tropical Medicine and Hygiene, which publishes the journal, and Director of the Center for Global Health and Diseases at Case Western Reserve University. "To reach that goal, evaluating the effectiveness of all our disease control efforts will help policymakers to make appropriate, evidence-based decisions."

Explore further: Ukraine urged to step up AIDS fight

Related Stories

Ukraine urged to step up AIDS fight

January 16, 2012
(AP) -- The head of a global health fund on Monday urged Ukraine to step up its efforts to fight the HIV/AIDS epidemic, Europe's largest.

HIV/AIDS: Progress and concerns three decades later

June 13, 2011
(Medical Xpress) -- When Michael Jonas learned he was HIV positive, he returned from Florida to his home in Jackson, Mich., to die.

Recommended for you

Scientists find where HIV 'hides' to evade detection by the immune system

October 19, 2017
In a decades-long game of hide and seek, scientists from Sydney's Westmead Institute for Medical Research have confirmed for the very first time the specific immune memory T-cells where infectious HIV 'hides' in the human ...

National roll-out of PrEP HIV prevention drug would be cost-effective

October 18, 2017
Providing pre-exposure prophylaxis (PrEP) medication to men who have sex with men who are at high risk of HIV infection (equivalent to less than 5% of men who have sex with men at any point in time) in England would be cost-effective, ...

Regulatory T cells harbor HIV/SIV virus during antiviral drug treatment

October 17, 2017
Scientists at Yerkes National Primate Research Center, Emory University have identified an additional part of the HIV reservoir, immune cells that survive and harbor the virus despite long-term treatment with antiviral drugs.

New research opens the door to 'functional cure' for HIV

October 17, 2017
In findings that open the door to a completely different approach to curing HIV infections, scientists from the Florida campus of The Scripps Research Institute (TSRI) have for the first time shown that a novel compound effectively ...

Researchers create molecule that could 'kick and kill' HIV

October 5, 2017
Current anti-AIDS drugs are highly effective at making HIV undetectable and allowing people with the virus to live longer, healthier lives. The treatments, a class of medications called antiretroviral therapy, also greatly ...

A sixth of new HIV patients in Europe 50 or older: study

September 27, 2017
People aged 50 and older comprise a growing percentage of HIV patients in Europe, accounting for one in six new cases in 2015, researchers said Wednesday.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.