AIDS fund awards get off to bumpy start
AIDS fund awards get off to bumpy start
Crucial step, but long way to go
The first round of awards by the Global Fund to Fight AIDS, TB and Malaria was marked by a flurry of publicity, some accolades, some complaints — and calls for much more money, much faster.
Harvard economist Jeff Sachs compared the April 29th awards to "the first moon launch," while Jim Kim, MD, PhD, executive director of Cambridge, MA-based Partners in Health, dubbed it "a Rosa Parks moment," referring to the civil rights-era figure who galvanized a successful strike against a public transportation system.
Yet several groups charged that the fund’s original intent — to get treatment to AIDS victims — was intentionally subverted, in part because rich countries pressured poor ones to scale back requests for costly treatment programs. "Only six applications had substantial treatment components for people with AIDS," says Paul Davis of ACT-UP, the Philadelphia-based AIDS activist group that has helped move the global AIDS treatment issue to the forefront of the political agenda. "One reason was because bilateral donors put the thumbscrews to developing countries, forcing them to ratchet down the size of requests," he adds.
At the New York offices of Medecins Sans Frontieres, spokeswoman Chris Torgeson agrees with Davis: "That did happen," she says. "People close to the selection process know that it did."
A doomsday scenario
Regardless of whether the first round of awards was mishandled, Kim and Sachs say the main problem is that a lot more money is needed. "I’ve heard the first round will provide antiretroviral treatment for between 30,000 and 60,000 people," says Kim. "That’s a good step, and the first time any money has ever been given for antiretroviral treatment. But now we have to move far beyond that, and come up with much more effective strategies."
The Central Intelligence Agency, Kim notes, recently issued a chilling prediction. A CIA expert has said that the numbers of HIV-infected people in two of Africa’s most populous countries are rising so quickly that by 2005, the total number of infected adults on the continent may almost double, rising to 64 million.
That raises the almost inconceivable specter of a continent where fully half the adult population will die an untimely death; where food production has fallen by as much as 40%; and where widespread famine stalks the land. "This is going to be a huge, huge problem," adds Kim.
With only about $700,000 on hand, the fund handed out awards totaling $616 million in April. The grants ranged in size from $93 million for a five-year AIDS program in South Africa to $570,000 awarded to a two-year project in Panama. About 60% of the money went to finance AIDS programs, with the rest divided between TB and malaria programs. The three diseases together account for one in ten deaths that occur each year globally and one in three that occur each year in sub-Saharan Africa.
That’s a far cry from what’s truly needed, experts agree. According to Sachs, it will take about $8 billion a year to implement what he calls a "comprehensive global program," with elements of prevention, treatment of opportunistic infections, and moderate use of triple-therapy antiretroviral medication.
Though U.S. contributions to the fund total only $300 million so far, there are at least three different bills in the Senate that would increase contributions if they passed:
• Senators Dick Durbin (D-IL) and Arlen Specter (R-PA) are pushing for $700,000 to be tacked onto an emergency spending act that includes billions for military spending.
• In a concurrent move, Senators Jesse Helms (R-NC) and Bill Frist (R-TN) are seeking to add $500 million to the same emergency spending bill. The Helms-Frist money was originally intended for prevention of mother-to-child HIV transmission, but signs from the Helms camp suggest that designating it for treatment of AIDS victims is also acceptable to its sponsors.
• Senators Gordon Smith (R-OR) and Barbara Boxer (D-CA) introduced an international TB control bill that would increase funding for global TB by $200 million. Negotiations are under way to shoehorn the Smith-Boxer bill into the emergency spending bill to create a sort of "superfund bill" for global health.
Emergency spending appropriations become available immediately upon approval, thus bypassing the drawn-out wrangling that accompanies ordinary bills. At least one of the proposals afoot is expected to be approved by November, when the Global Fund will hand out a second round of awards, Hill-watchers say.
In a searing speech delivered to the Senate Foreign Relations Committee last month, Sachs said the U.S. needs to spend much more on infectious diseases globally. Over the past five years, the U.S. has committed only $55 million to fighting AIDS in developing countries, he noted. With less than 0.1% of its gross domestic product committed to all foreign aid, that makes America the stingiest generous donor on earth as measured by percentage of gross national income.
Sachs described a visit he’d made in March to Queen Elizabeth Hospital in Malawi, where 70% of admissions are AIDS-related. "Hundreds of people [were] crowded into the wards to die, two to three to a bed, with patients also lying on the floor under the beds," he said. Yet across the hall in the outpatient ward, the small fraction of patients able to purchase antiretrovirals were being successfully treated, he added.
"The problem in the hospital is not infrastructure, doctors, testing equipment, adherence by patients, or the ability to tell time," Sachs told the senators. "It is simply the shortage of $1 a day per patient that would supply the life-saving drugs." Even when the cost of testing and counseling the HIV-infected is factored in, the sum is less than $3 per day, he added.
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