AIDS is a catastrophe of unprecedented historical proportions. Since the
epidemic began, 22 million people have died, 17 million in Africa. There
are 13 million AIDS orphans in Africa and it is estimated that the number
will grow to 40 million by the end of this decade without massive
In rich countries, drug cocktails have been remarkably successful in
making AIDS a chronic disease like diabetes or hypertension. AIDS
mortality dropped by over half within a few years of making such treatment
available. In poor countries, less than 1/10 of 1% of the people with AIDS
are being treated. Without access to medicine, almost all of the 36
million people living with AIDS will die. In the past several months, the
principal objections to enhancing access to AIDS treatment have been
overcome; now is the time to advocate for universal treatment.
Treatment cost over $15,000 per person per year until activists and
developing country pharmaceutical companies forced the big companies to
reduce prices to as low as $350 per person per year. The medical
infrastructure required to manage AIDS has now been simplified; after the
first several weeks, only 2-4 blood tests per year are required for
monitoring. Adherence to medications (two pills, one each in the morning
and evening) has been shown to be as good in poor countries as rich ones.
Prevention efforts, which have lagged in much of Africa, have been given a
huge boost by availability of treatment in Brazil and Botswana. Experience
has shown that people are much more likely to be tested and stigma easier
to reduce when treatment is available.
How much money is really needed for AIDS treatment?
Estimates vary, depending how broad the interventions might be. A Harvard
Faculty Consensus Statement has estimated that the cost of treatment for
the 1-3 million HIV-infected Africans would be $1,100 per patient per year
for a total of $1.1 - $3.3 Billion/year; this quantity includes drugs,
testing, directly observed therapy, clinical support and research.
Extending this program to the rest of the world, the total tab would be
$4.2 Billion. Additional money would be needed to sustain prevention
efforts. All in all, it is a small price to pay. The figure is about one
cent per $100 in the GNP of rich countries and significantly less than the
worldwide development assistance target of 1% of GNP.
The United States has proposed a contribution of $200 million to the
Global Fund, although they have suggested more money will be made
available next year, if the fund performs acceptably. In this way the Bush
Administration is setting the bar so low that the fund will be starved of
resources before it starts. Given the shortage of money, policy makers
will argue against providing treatment at all choosing instead to focus
solely on prevention. If history is our guide, HIV prevention efforts
will have limited success without availability of treatment.
We propose the following to the US congress:
1) Legislation that would authorize the United States to contribute in a
meaningful way ($2 billion annually) to the Global Fund for AIDS.
2) It is important that contributions to the Global AIDS and Health Fund
are in addition to funds administered by USAID. The global fund will be
able to serve many functions that bilateral aid programs cannot
effectively carry out.
For more information about this complex issue, check out the Student
Global AIDS Campaign's report on the
crisis, the recent
article by Leon Spencer in the November 2001 Africa
Advocacy Public Policy Newsletter, or any of the websites on our links page.