By Lisa Vives, Global Information Network
NEW YORK | AMSTERDAM (IDN) – The International Conference on AIDS (AIDS 2018) – the largest gathering on any global health issue in the world – opened in Amsterdam, the Netherlands, on July 23 under the title Breaking Barriers, Building Bridges.
With hundreds of scheduled talks and roundtables, the five-day 22nd International AIDS Conference has defined its goal as promoting human rights-based and evidence-informed HIV responses tailored to the needs of people living with HIV, displaced populations, gays, people who use drugs, sex workers, transgender people, women and girls and young people – and collaborating in fighting the disease beyond country borders.
A two-day event preceding the conference considered practical solutions to funding effective and efficient HIV and AIDS programs and sustain the results considering declining donor funding.
In South Africa, the number of new HIV infections is dropping‚ but there were still 231‚000 new infections in 2017. Condom usage has been decreasing and the number of people having sex before the age of 15 has been increasing, say researchers.
The group where new infections are growing at the highest rate is young men aged 14 to 24.
In East and Southern Africa, more than half of people dying of AIDS related illnesses were men and boys, although they represent only 46% of those infected with HIV in the region, according to UNAIDS’ 2017 Global AIDS update.
Why? Because fewer men than women get tested for HIV, says the UN. Studies show that in East and Southern African countries, men are significantly less likely than women to have been tested for HIV and therefore do not know their HIV status.
As a result, fewer men are on antiretroviral therapy and for those who receive treatment at a later stage, treatment is sometimes less effective.
A different picture emerges in Nigeria where according to the recently released Joint UN Program on HIV/AIDS report for 2018, there are more women in that country living with HIV – particularly adolescent girls and young women – than men. Nigeria now has 1.6 million HIV-infected women in Nigeria in comparison to 1.3 million men in 2017.
According to new research presented at the Conference on July 24 warned that if donor government funding for HIV continues to fall, nearly two decades of progress against the disease will be in jeopardy,
Using newly available data, a study from researchers at the Institute for Health Metrics and Evaluation and the Harvard T.H. Chan School of Public Health showed that cuts to development assistance for HIV could do serious harm in hard-hit countries, which continue to rely greatly on this aid.
“If donors falter in their support for HIV, the consequences could be devastating,” Linda-Gail Bekker, President of the International AIDS Society and International Chair of AIDS 2018, said. “Smart investments are curbing the spread of HIV and saving both money and lives. Now is not the time to stall or pull back.”
A report issued on July 18 by the Kaiser Family Foundation and UNAIDS found that eight of 14 donor governments reduced their spending on global HIV efforts in 2017. Overall, donor government funding for HIV increased from 2016 to 2017, following two years of declines. However, this increase was largely due to a shift in timing of U.S. support, and is not expected to last.
The press briefing on July 24, chaired by Jennifer Kates of Kaiser Family Foundation, highlighted the results of three new studies.
Declines in development assistance for HIV
To date, there has been limited data on whether the downward trend in development assistance for HIV threatens global progress against the disease.
To address this and other research questions, a study presented by Annie Haakenstad of the Harvard T.H. Chan School of Public Health estimated HIV expenditures by source and function in 188 countries from 2000 to 2015. The results showed that of the $48 billion spent on HIV in 2015, about 62% came from domestic spending by governments and about 30% came from development assistance. In countries with high HIV prevalence, however, nearly 80% of spending came from development assistance.
The study concluded that development assistance remains a major portion of spending on critical HIV prevention and treatment programmes, especially in the hardest-hit countries. The study team urged high-prevalence countries that rely on international aid to plan strategically to ensure that declines in external financing do not threaten progress towards an AIDS-free generation.
Low- and middle-income countries increase HIV spending
A study presented by Deepak Mattur of UNAIDS provided new insight on trends in domestic HIV spending, based on an analysis of data from 112 low- and middle-income countries.
The study found that, overall, domestic public spending on HIV in these countries increased by 60% from 2006 to 2016. In low-income countries, it increased from $121 million to $256 million; in lower-middle income countries, from $231 million to $980 million; and in upper-middle income countries, from $2.4 billion to about $6.9 billion.
Almost all regions increased their domestic HIV resources. For example, in the Asia Pacific region, resources increased by 132%, and in Eastern and Southern Africa, resources increased by 57%. The lowest increase, 33%, was in Eastern Europe and Central Asia.
The study also found that domestic public spending on HIV has a significant positive relationship with the GDP per capita of a country, coverage of antiretroviral therapy, and HIV prevalence.
The study concluded that sustained increases in domestic public spending will be critical for ending AIDS as a global public health threat by 2030.
HIV resources are generally well targeted, but can be optimized
A study presented by John Stover of Avenir Health in Glastonbury, U.S., investigated how well the current allocation of resources for HIV is optimized for cost effectiveness in 55 low- and middle-income countries that account for about 90% of all new infections.
The study found that cost effectiveness varies widely across countries and interventions. Antiretroviral treatment dominates cost per death and disability adjusted life years averted, and also ranks high in cost effectiveness for infections averted.
The most cost-effective prevention interventions were generally voluntary medical male circumcision, prevention of mother-to-child HIV transmission, outreach to sex workers and condom promotion. These programmes currently receive about 14% of direct intervention funding, which is about two-thirds of the need. The most cost-effective programmes are in East and Southern Africa, where HIV incidence is high and costs are generally low.
The authors concluded that resources for HIV prevention and treatment are generally targeted appropriately, but more focused allocation of resources could improve cost effectiveness by about a quarter. Resource allocations should be continually assessed because cost effectiveness can change significantly as HIV incidence patterns change. [IDN-InDepthNews – 25 July 2018]
Photo: AIDS-2018-march. Credit: smugmug.com
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