By: Marcus Ostermiller
The recent boost in HIV/AIDS funding has ignited a protest among many members of the global health community: that by investing heavily in HIV we are unjustly neglecting other important global health crises. While it is true that the funding for HIV surpasses other priorities, the situation is not as black and white as it may seem. Studies suggest that the fight against HIV has indirectly bolstered other global health concerns. Diminishing funding for HIV/AIDS in favor of other priorities would, in fact, serve as a detriment to non-HIV initiatives.
A substantial percentage of global HIV/AIDS expenditures are devoted to health systems and infrastructure that benefit many other health priorities. The Global Fund and PEPFAR are among the largest donors to global health systems. A 2009 report showed that 35% of the Global Fund’s spending was devoted to human resources, infrastructure, medical equipment, monitoring and evaluation. PEPFAR spent $4 billion on health systems between 2004 and 2009. The services that these dollars provide extend far beyond the boundaries of HIV (Piot).
A 2009 case study in Rwanda illustrates how the increase in funding for HIV/AIDS has broadly benefited other health concerns. Two months following the introduction of HAART at seven PEPFAR sites in Rwanda, new HIV-related hospital admissions dropped by 21 percent. As a result, Rwanda saw a drastic increase in the availability of clinics, resources, and healthcare workers for other non-HIV priorities. By strengthening HIV/AIDS efforts in Rwanda, health resources were essentially liberated.
In 2009 the Obama administration announced a reauthorization of PEPFAR, which included $51 billion for HIV/AIDS and $12 billion for other priorities including maternal and child health (MCH) via an innovative program called the Mother and Child Campaign. The architects of this program proposed that PEPFAR increase funding for MCH at the expense of future HIV funding. Sarah C. Leeper and Anand Reddi argue that this course of action would adversely affect MCH because HIV/AIDS programs indirectly support MCH. They argue that many MCH-related deaths in Sub-Saharan Africa are classified as opportunistic infections when they, in fact, originate from suppressed immunity of HIV infection. According to Leeper and Reddi, HIV/AIDS funding benefits MCH in the following ways:
- Strengthening immunity in both mothers and children decreases the prevalence of opportunistic infections (pneumonia, etc).
- Treating HIV-positive mothers improves their ability to care for children, provide proper nutrition and economic security.
- “Failure to use HAART is more expensive than HAART itself” (Leeper and Reddi, 2147).
Furthermore, PEPFAR has generously supported non-AIDS diseases, revitalized health facilities, and increased the number of doctors and healthcare professionals. The Mother and Child Campaign’s goals for stronger MCH initiatives should not come at the expense of HIV/AIDS.
While HIV/AIDS is clearly not the only global health concern, it offers indirect benefits for non-HIV priorities. Decreasing HIV/AIDS funding will have a detrimental impact on MCH, as well as many other global health initiatives. The recent strides in the fight against HIV/AIDS should be viewed in a positive light, and measures should be taken to continue the recent momentum. Benefits are found not only within the HIV/AIDS realm, but also throughout many other global health priorities.
Leeper, S and Reddi, A. (2010) “United States global health policy: HIV/AIDS, maternal and child health, and The President’s Emergency Plan for AIDS Relief (PEPFAR)” AIDS 24:2145–2149.
Piot, P, Kaztchkine, M, Dybul, M, Lob-Levyt, J. (2009) “AIDS: lessons learnt and myths dispelled.” Lancet. Published online March 20, 2009.
Price, JE, Micomyiza, E, Nyeimana, V, Tchupo J. (2007) “Integrating HIV clinical services in primary health care centers in Rwanda: effect on the quantity on non-HIV services delivered.” HIV Implementers Meeting; Kigali, Rwanda; June 17, 2007.