HIV funding cutbacks: severe health outcomes for minimal financial gains
Savings would be ‘small and transient’ – raising significant ethical and efficacy concerns about the benefit of US budget cuts for HIV programming abroad.
Cutbacks of US funding of HIV programmes in South Africa and Cote d’Ivoire would have minimal financial gains for the adverse clinical outcomes they would create. Over ten years, the researchers from Massachusetts General Hospital (MGH) and the Yale School of Public Health estimated that nine million life years would be lost.
Without appropriate funding, new HIV infections in these two countries have the potential to increase by 19% with a further 39% rise in fatalities due to AIDS-related deaths. Budget-saving strategies would only ever produce savings of up to 30%, thanks to current US commitments that see no person living with HIV and currently on treatment losing it.
The research, published in the Annals of Internal Medicine on Monday (4 September), is the first to estimate projected clinical and epidemiologic outcomes of the scaling back of US aid to international HIV programmes.
The proposed 33% cutback on funding for these types of programmes in the 2018 financial year would result in savings of just $900 per year of life lost in South Africa and Cote d’Ivoire – raising significant efficacy and ethical concerns about the budget cuts.
Lead author, Rochelle P. Walensky, M.D., of the MGH Division of Infectious Disease said: “Over the past decade and a half, we’ve spent considerable money to save lives in these and other African nations. Would the relatively small savings realised by currently proposed budget reductions be worth these large humanitarian costs?”
Mathematical modelling was used to analyse the savings made by the budget cuts - assessing how many new HIV infections and deaths would occur, and how many additional years of life would be lost.
Strategies modelled included the scaling back HIV screening activities, restricting access to antiretroviral treatment (ART) to only the sickest patients, eliminating backup treatment strategies for patients who do not respond to initial therapies, minimising laboratory monitoring of diagnosed patients and decreasing efforts to retain patients in care.
In a strategy that would include restricting access to ART, in South Africa alone, some 1.6 million people would die over ten years and half a million new HIV infections would occur.
Results also indicated that any initial savings made via cutbacks would be eventually eaten away after ten years thanks to increased levels of new HIV infections and people in need of treatment.
Donor fatigue and political resistance are blamed for diminishing investment in global HIV programmes and receiving countries need to be aware of the potential damage this has on their epidemic, if the financial slack is not to be picked up elsewhere.
UNAIDS now calls for countries to increase funding towards their own HIV responses, to ensure sustainability and ownership. However, the astronomical costs of HIV prevention and treatment programmes continue to be a challenge.
Senior author A. David Paltiel, Ph.D., professor at the Yale School of Public Health, said: “Our aim is to confront donor nations with the clinical and economic consequences of any decision to substantially cut HIV program funding and to help recipient nations respond in the least harmful ways possible to the actions of countries in the developed world.”