Gray Area

HIV/AIDS has become, over the course of the past twenty years, the single most emphasized disease within the global health community and beyond.  Total development assistance for health, from both private and public donors, has increased dramatically over the past decade, and more than half of these funds are directed toward HIV/AIDS programs.  Should we be spending such a large percentage of health assistance on HIV/AIDS, rather than other diseases, when HIV/AIDS is not the leading global cause of morbidity and mortality?  Could the emphasis on HIV/AIDS be detrimental to already struggling health systems and disease programs in the developing world, ignoring other important diseases such as malaria or diarrhea?  Opinions within the global health community on the effects of HIV/AIDS assistance on health outcomes in the developing world are varied, and the answers to these questions are by no means black and white.

Laurie Garrett points out that while some HIV/AIDS programs have been successful, these initiatives are responsible for detracting much-needed medical professionals away from the public sector and into hospitals and clinics run by NGO’s or other foreign programs.  Pulling human resources out of the public sector further cripples weak public health systems in the developing world.  Additionally, the reliance on foreign aid in HIV/AIDS programs is not sustainable.  Developing nations cannot be guaranteed a steady flow of foreign assistance, as political and economic situations in donor countries are constantly shifting.  In fact, the effects of this current global economic crisis are already becoming visible, as nations adjust their global health spending.  Furthermore, in nations, such as Haiti where HIV/AIDS programs have been heavily emphasized, there have been improvements in health outcomes related to HIV/AIDS, but the burdens of other diseases have increased.  By focusing intently on HIV/AIDS funding, we neglect funding for health systems and a multitude of other diseases that afflict those living in the developing world.

Others within the global health community hold drastically different views than those of Garrett, arguing that improved outcomes for HIV/AIDS and increased prevention and treatment measures will eventually trickle down to allow for successes in other disease areas and improvements in the health system more broadly.  Hospitals built using foreign money for HIV/AIDS tend to be cleaner and more efficient than public-sector facilities.  Improving ART coverage and implementing effective prevention programs will increase the productivity of the workforce, allowing for economic growth and expansion.  The attention given to HIV/AIDS has created greater interest in global health more broadly from the international community.  After all, it was in part the HIV/AIDS pandemic that prompted the recent outpour in development assistance for health, much of which is being directed toward other disease programs and health sector support.  Would many of the disease programs in place today even exist if it weren’t for HIV/AIDS?

Who’s right, and who’s wrong?  It is hard to say.  Perhaps this answer will become clearer in the coming years, as we begin to see the impact of current programs.  Until then, this debate is bound to become only murkier.

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