New Strategies Needed to End AIDS Epidemic, Speakers Say

New strategies are needed to take advantage of scientific breakthroughs that promise to break the back of an AIDS epidemic that last year killed more than 4,000 people a day worldwide, U.S. and global officials said.

In opening remarks yesterday at the International AIDS Conference in Washington, U.S. Health Secretary Kathleen Sebelius led a parade of speakers with similar messages: The world needs to be more focused and efficient in getting therapies and preventatives to those in need.

“If we are going to reach our ultimate goal of an AIDS-free generation, we must challenge ourselves to do more,” Sebelius said in her comments yesterday.

None of the speakers, though, offered specific programs to increase global access to needed treatments. And the emphasis on an epidemic endgame comes as the Obama Administration has said it plans to decrease funding for global AIDS programs in fiscal 2013. The U.S. isn’t alone in taking such an action, said Michel Sidibe, of the United Nations organization, UNAIDS.

“From many places in the developed world I am hearing, ’we cannot afford to keep our promises. We have our own problems at home,”’ Sidibe, the groups’ executive director, said in his remarks to the conference. “Financial commitment from developed countries is declining. We have a funding gap of $7 billion per year for HIV. This gap is killing people.”

Gilead’s Truvada

Over the last two years, scientists have found that a daily pill, Gilead Sciences Inc.’s Truvada, can reduce the risk of healthy people getting HIV by as much as 94 percent, and that early treatment can stop infected people from spreading the virus. What’s lacking is the money to convert that knowledge into action, said Chris Collins, a vice president at amfAR, the Foundation for AIDS Research.

“We are at risk of not following through on one of the great global health opportunities of our generation,” Collins said in a telephone interview. “Either we make more investment now, and really begin to see the end of this, or we don’t do that and see this epidemic go on for generations.”

A record 34.2 million people worldwide are living with HIV, according to the World Health Organization. In South Africa alone, a country where almost 1 in 3 people survive on less than $2 a day, 18 percent of those ages 15 to 49 are infected, the data shows.

Other opening-day speakers at the AIDS conference included World Bank president Jim Yong Kim and South African deputy president Kgalema Petrus Motlanthe. Kim warned that the AIDS epidemic is an economic crisis as well as a human one.

Economic Impact

“AIDS has devastating economic and social impacts on individuals, families and communities,” Kim said. “We will need more innovation in the years ahead to finish the fight.”

The conference, to be attended by more than 20,000 activists and researchers from around the world, comes at an awkward time for President Barack Obama.

Former President George W. Bush, a Republican, more than tripled U.S. funding for global treatment during the last five years of his administration through the President’s Emergency Plan for Aids Relief, or PEPFAR. With that increase, U.S. funding covered about 59 percent of all donations for global AIDS relief, according to Jennifer Kates, director of global health and HIV policy for the nonprofit Kaiser Family Foundation, of Menlo Park, California.

In 2010, the PEPFAR budget was $6.9 billion, including money to combat tuberculosis, the leading killer of AIDS patients. If Obama’s current budget plan is enacted, the funding will fall to $6.4 billion in fiscal 2013.

Resource Motor

The U.S. believes other countries need to carry a larger part of the financial load in the future, Eric Goosby, Obama’s Global AIDS Coordinator, said in an interview.

“The United States can’t be ministries of health for all of these countries,” Goosby said. “Our best chance at not having the United States be the predominant resource motor for HIV treatment and HIV/TB treatment on the planet is to bring others to the table to put their resources to it.”

Even with diminished funding, the U.S. can increase the number of people treated going forward because much of the spending on infrastructure, including clinic construction and the training of health-care workers, is done, he said. Additionally about 98 percent of drugs used now are cheaper generics, according to Goosby.

The average cost of a year’s supply of drugs has fallen to $100 a person in the lowest income countries from $10,000 a year in 2000, according to data from the WHO.

Cuts Questioned

Still, the funding cuts are being questioned even by some in the president’s own Democratic Party, at a time of extraordinary scientific progress against the disease.

“We cannot walk away thinking we’ve done our part and it’s on them now if we are serious about our goal of an AIDS-free generation,” said Congressman James McDermott, a Democrat from Washington, during a July 10 forum on the PEPFAR funding.

Representative Barbara Lee, a California Democrat, said AIDS is no longer a priority for most law makers in Washington.

“It is about priorities; we have the resources,” Lee said in an interview. “The focus seems really to be on dismantling all our government programs, and HIV/AIDS initiatives are caught up in that overall policy.”

In Africa, the funding cuts over the past two years are already being felt, according to Teguest Guerma, director general of the African Medical and Research Foundation.

Guerma, whose group is the largest African-based non-government health organization, said some already infected patients have lost access to the free drugs they were getting through the U.S. program, and there’s little chance of ready access to Truvada for uninfected people at high-risk of contracting the virus, such as sex workers and truck drivers.

Out of Reach

While AIDS medications can cost as little as $8 a month in some countries, that’s still out of reach for many in Africa who live on less than $1 a day, according to Guerma, whose headquarters are in Nairobi, Kenya.

African countries have been increasing funding to meet the demand, she said, with low and middle income countries spending about 15 percent more on domestic HIV programs last year, for a total of about $8.6 billion. Still, it’s not enough, she said.

“Money is getting lower and lower,” Guerma said. “But the need is still there.”

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