Now Is Not the Time to Step Back from Global AIDS Funding

NPR's Morning Edition recently reported on a visit to Capitol Hill by the Afghanistan Minister of Health Sayid Fatimie. This short report asked the question: should foreign aid for global health be viewed as a way of helping poor countries or should it serve foreign policy objectives? In looking at this question, NPR also suggested a false opposition that I have noticed in global health funding conversations: funding for HIV/AIDS is pitted against support for other global health programs. In this case, US funding for international HIV/AIDS programs is seen as competing with US funding for maternal mortality in Afghanistan.The funding conversation should not pit diseases against each other in a competition for funding. Instead, we should concentrate on ensuring that enough funding is available guarantee basic health for all.NPR host Steve Inskeep noted that US assistance for the health sector in Afghanistan is crucial—especially for maternal and child health. Afghanistan has the second highest rate of maternal and child mortality.? Globally, over 500,000 women die each year in childbirth or during pregnancy—unnecessary loss of life and an unacceptable statistic. Maternal mortality is not only a health issue—it is a human rights issue—specifically a woman’s human right to life, health, equality and non-discrimination, amongst other human rights. Many of these deaths are preventable and would not require a huge investment to address.PHR welcomes the increase of funding in this area by the Obama Administration. Financial support for maternal health has remained stagnant or even declined over the past decade. At the same time it is essential that the US commit to scaling up HIV/AIDS prevention and treatment programs. The AIDS pandemic appropriately prompted an international response to what is a huge health crisis. The pandemic catalyzed the political will necessary for an ambitious commitment of resources to global health and engaged an active and vocal global community that ranged from people living with HIV/AIDS, to international organisations, to the private sector. Now is not the time to step back.A recent article, by Peter Piot, Prof Michel Kazatchkine, Mark Dybul, Julian Lob-Levyt, called "AIDS: lessons learnt and myths dispelled," points out that while there is a decrease in rates and fewer AIDS-related deaths, the pandemic is not over. Some argue that the pandemic has shifted money away from other critical public health issues and general health systems strengthening. Piot et al?note that the reality is that the resources to fight AIDS have frequently had the reverse effect: from the provision of laboratory services in Nicaragua, to the freeing up of health workers in Rwanda, to the refurbishment of health centers—including delivery suites, which not only help to prevent mother to child transmission of HIV, but also maternal deaths. Piot et al also note that both the Global Fund to fight HIV/AIDS, Tuberculosis and Malaria and the President’s Emergency Fund for AIDS Relief (PEPFAR) include components for health systems strengthening.It is time to move away from the pitting of one disease or health issue against another. We need to build upon the momentum developed in response to the AIDS pandemic and ensure that the US keeps its commitment to addressing HIV/AIDS and other critical global health initiatives such as maternal and child health. HIV/AIDS specialist Ken Mayor, MD, pointed out that?AIDS money can continue to assist with addressing other health issues as health workers trained under PEPFAR have skills that can be used in other programs. ?As Pat Daoust, PHRs Health Action AIDS Campaign Director said, in a letter to the editor of the Boston Globe:

[W]e must remember that the United States has the resources and the responsibility to keep its promise to scaling up HIV/AIDS treatment and prevention programs while at the same time strengthening its commitment to other critical global health initiatives. The nation’s leaders must commit to doing both.

The recession is affecting people everywhere, particularly the most vulnerable. People with HIV/AIDS are still at risk. Disruptions in the supply of ARVs are occurring in many countries in Africa. People in need of ARV therapy are being turned-away. Reductions in funding will negatively affect accepted standards of care, are potentially a death sentence for those who are HIV-positive and may result in health-worker layoffs and hence fewer people to monitor and treat people with HIV infection. By keeping its promise, the US will be assisting countries to address not only HIV/AIDS but also maternal and child health, including maternal mortality, and other country identified priority health issues.

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