Too soon for rich countries to stop HIV funding in poor ones

July 4, 2014 by David Wilson And Braedon Donald, The Conversation

The global HIV epidemic has been unprecedented, both in its extent and in the way it has changed the world's approach to health funding.

Over the last ten to 15 years, large sums of money have for the first time been systematically transferred from the richest to the in order to provide emergency HIV prevention and .

Despite inefficiencies and setbacks, this investment has resulted in tremendous health and economic savings in these countries. AIDS is now generally reversible for people who receive .

As we are no longer in an era of an emergency response, HIV can now be considered a chronic disease. This means it could be brought into the management of national public and clinical health programs and not be funded primarily from external sources.

Not quite ready

As a result, the international community expects governments of low- and middle-income countries to invest more funds in their HIV responses, and to move towards fully domestically financed responses.

But the political, social, economic and infrastructural factors in many low- and middle-income countries preclude domestic leadership for comprehensive HIV responses. Several countries in south-east Asia, for instance, have de-emphasised or completely rejected HIV prevention programs targeted at key affected populations, such as sex workers and drug users.

These decisions will undoubtedly have negative health and economic consequences. And they raise questions about whether the global community should continue to fund such programs, advocate more strongly for their ownership domestically, or withdraw and allow countries to decide their own priorities.

The right answer is probably a nuanced combination of all of the above because it's not just a matter of lack of local enthusiasm.

Progressing to middle-income status has made some countries ineligible to receive multilateral funds. But many of these countries are not actually economically able or technically ready to take over.

Consider Indonesia, which has a growing HIV epidemic. It funded approximately 50% of its overall HIV response prior to donor withdrawal, so clearly needs to substantially increase funding for prevention and treatment programs if the epidemic is to be contained. But the sudden lack of funding means some programs are likely to be discontinued completely.

Surely, international funding decisions should not be based on a single economic indicator but pertain to epidemic burden and other capacity. Donor assistance is still required during the transition to domestic ownership of both treatment and prevention programs.

Without sustained funding during this time, the gains achieved to date may be lost.

Better health systems

HIV has also raised considerations of health system capacity. We now have evidence of proven technologies and treatments for HIV prevention and care, so we know what to deliver. But we don't have a good understanding of how to deliver it with quality and to scale.

Implementing what we know works in the context of fragile health systems and their infrastructure in low- and middle-income countries requires urgent attention. Clearly, any domestic response to HIV must utilise existing infrastructure to maximise efficiency and overall integration into health systems.

This leads to the largest game-changer necessary for low- and middle-income to transition to sustained domestic responses – complete antiretroviral packages. This includes care and support and should be included in universal health-care schemes.

And HIV prevention programs should be integrated into existing health and social programs to improve the efficiency of spending on HIV programs.

Responding to the challenge of HIV has successfully put inequity on funding agendas, highlighting the importance of equity when allocating resources.

HIV has also raised attention to providing support not only to the economically vulnerable but to socially vulnerable people too.

Explore further: Millions in need of HIV services will continue to be left out

Related Stories

Millions in need of HIV services will continue to be left out

July 1, 2014
Millions of people in need would benefit from HIV services in developing countries that are moving towards universal health coverage if these services were run more efficiently and integrated better into their health systems.

Aging with HIV and AIDS: A growing social issue

June 25, 2014
As the first people with HIV grow old, a new study from St. Michael's Hospital questions whether the health care system and other government policies are prepared to meet their complex medical and social needs.

Emerging HIV epidemics among people who inject drugs in the Middle East and North Africa

June 19, 2014
HIV epidemics are emerging among people who inject drugs in several countries in the Middle East and North Africa. Though HIV infection levels were historically very low in the Middle East and North Africa, substantial levels ...

Herpes virus infection drives HIV infection among non-injecting drug users in New York

June 28, 2014
HIV and its transmission has long been associated with injecting drug use, where hypodermic syringes are used to administer illicit drugs. Now, a newly reported study by researchers affiliated with New York University's Center ...

In developing countries, female sex workers 14 times more likely to become infected by HIV

March 14, 2012
Female sex workers in low- and middle-income countries are nearly 14 times more likely to be infected by HIV compared to the rest of country's population, according to an analysis by researchers at the Johns Hopkins Bloomberg ...

Cutting HIV in drug users can benefit others' AIDS mortality

March 26, 2014
(HealthDay)—Efforts to curb HIV transmission among people who inject drugs (PWID) and non-injecting drug users (NIDUs) may reduce AIDS and AIDS-related mortality among heterosexuals, according to a study published in the ...

Recommended for you

HIV-1 genetic diversity is higher in vaginal tract than in blood during early infection

January 18, 2018
A first-of-its-kind study has found that the genetic diversity of human immunodeficiency virus type 1 (HIV-1) is higher in the vaginal tract than in the blood stream during early infection. This finding, published in PLOS ...

War in Ukraine has escalated HIV spread in the country: study

January 15, 2018
Conflict in Ukraine has increased the risk of HIV outbreaks throughout the country as displaced HIV-infected people move from war-affected regions to areas with higher risk of transmission, according to analysis by scientists.

Researchers offer new model for uncovering true HIV mortality rates in Zambia

January 12, 2018
A new study that seeks to better ascertain HIV mortality rates in Zambia could provide a model for improved national and regional surveillance approaches, and ultimately, more effective HIV treatment strategies.

New drug capsule may allow weekly HIV treatment

January 9, 2018
Researchers at MIT and Brigham and Women's Hospital have developed a capsule that can deliver a week's worth of HIV drugs in a single dose. This advance could make it much easier for patients to adhere to the strict schedule ...

New long-acting, less-toxic HIV drug suppresses virus in humanized mice

January 8, 2018
A team of Yale researchers tested a new chemical compound that suppresses HIV, protects immune cells, and remains effective for weeks with a single dose. In animal experiments, the compound proved to be a promising new candidate ...

Usage remains low for pill that can prevent HIV infection

January 8, 2018
From gritty neighborhoods in New York and Los Angeles to clinics in Kenya and Brazil, health workers are trying to popularize a pill that has proven highly effective in preventing HIV but which—in their view—remains woefully ...


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.