US aid cuts to HIV might cost lives without much savings
New study warns funding cutbacks would lead to new infections and more deaths
Reducing US foreign aid for HIV prevention and treatment might not save that much money in the long run, and it could lead to a surge in new infections and fatalities, a new study suggests.
A US budget proposal to reduce foreign aid by one-third would affect more than $6.7 billion currently earmarked for HIV/ Aids research, prevention and treatment, researchers note in the Annals of Internal Medicine, online
In South Africa alone, cutbacks could result in more than 500,000 additional cases of HIV and more than 1.6 million more deaths within the next decade, researchers estimate.
At most, the proposed budget cuts would save just $600 to $900 for every year of life lost in South Africa and the Ivory Coast, researchers estimated, because any initial savings would lead to high costs down the line to treat more people infected with HIV.
“This is not an epidemic we can kick down the road and think it will go away,” said lead study author Rochelle Walensky, an infectious disease researcher at Harvard Medical School and Massachusetts General Hospital in Boston.
“Loss of investment now will mean bigger problems and price tags later,” Dr Walensky said by email.
To assess the potential impact of foreign-aid cuts on the global effort to combat HIV, researchers compared current standards for starting antiretroviral therapy and keeping people on the drugs to what might occur with fewer resources.
Researchers looked at cost data from the Republic of South Africa and the Ivory Coast to see what might happen in each country if HIV screening was reduced, access to medication was limited to the sickest patients, access to alternative drugs when initial treatments don’t work was eliminated, and lab tests to monitor patients and efforts to keep people in long-term treatment were cut back.
They estimated how much money could be saved by each of these moves, how many new infections and deaths would occur, and how many additional years of life would be lost.
Existing commitments to patients already receiving care for HIV infection would restrict overall saving to no more than 30 per cent, the researchers estimated. As currently proposed, the US foreign-aid budget cuts would not reduce care for people already on treatment.
Over time, those savings would dry up, as the increase in HIV transmissions would lead to accumulating costs for the care of those patients, the researchers conclude.
One limitation of the study is that researchers don’t know what changes would actually be made to HIV prevention or treatment based on the proposed US foreign-aid cuts.
Even so, the analysis offers a preview of what could happen after cutting back investment in HIV prevention and treatment, said Arleen Leibowitz, a public policy researcher at the University of California, Los Angeles, who wasn’t involved in the study.
“Early antiretroviral treatment has a double benefit - it improves health and survival of the HIVinfected person, but also cuts down on transmission,” Leibowitz said by email. “This, in turn, will reduce longrun costs.”
When newly infected patients start antitretrovirals quickly, they can become non-contagious within two to three months, noted Eric Goosby of the University of California, San Francisco School of Medicine.
“The drop in the number of infections creates less utilisation of clinics, emergency services and inpatient service, thereby saving money,” Goosby, who wasn’t involved in the study, said by email.
Cutting back in HIV investments now would reverse extraordinary gains made in saving lives and reducing new HIV infections, said Diane Havlir, chair of the Unaids Science and Technology Advisory Committee.
“Such pullbacks would ensure we would pass on HIV epidemic for generations to come,” Dr Havlir, who wasn’t involved in the study, said by email.
Meanwhile US President Donald Trump’s plan to cut foreign aid supporting HIV/AIDS treatment could cost one million years of lost life in South Africa and Ivory Coast, according to a just-released global study released.
In the first study to measure the impact of cuts in global investment in HIV care in terms of health and costs, scientists found sky-rocketing deaths in the African nations would far outweigh savings.
South Africa has the highest prevalence of HIV worldwide, with 19 per cent of its adult population carrying the virus in 2015, according to Unaids, with a total of seven million Hiv-infected people.
Ivory Coast counted 460,000 Hivinfected people in that same year.
Trump’s proposed budget for 2018, made public in May, envisions cuts to the President’s Emergency Plan for Aids Relief (PEPFAR) programme, a cornerstone of US global health assistance, which supports HIV/AIDS treatment, testing and counseling for millions of people worldwide.
Under Trump’s budget, which pursues his “America First” world view, PEPFAR funding would be $5 billion per year compared to about $6 billion annually now, the US State Department has said. No patient currently receiving antiretroviral therapy, a treatment for HIV, through PEPFAR funds will lose that treatment, officials have said.
Should the cuts keep South Africans and Ivorians from receiving antiretroviral drugs, an additional 1.8 million Hiv-infected people would die over the next 10 years, 11 researchers in America, Europe and Africa concluded, using mathematical models.
The combined deaths amount to nearly nine million years of life lost, the scientists calculated, in what they said was the first effort to put figures on the proposed cuts.
The researchers measured expected savings over the next decade, whose small scale they said raised efficacy and ethical questions. In South Africa, it would amount to some $900 per year of life lost, compared to $600 to $900 in Ivory Coast.
“We leave it to readers to draw their own conclusions about whether imposing such trade-offs on vulnerable populations accurately reufb02ects how donor countries value life in recipient nations,” the researchers wrote in Annals of Internal Medicine.
Savings would eventually dry up over the decade, they found, due to higher costs tied to the spread of HIV amid scaled back screening and care.
“Would the relatively small savings realised by currently proposed budget reductions be worth these large humanitarian costs?” said lead author Rochelle Walensky, a professor of medicine at Harvard Medical School.
“Over the past decade and a half we’ve spent considerable money to save lives in these and other African nations.”
Some 90 per cent of Ivory Coast’s funding for HIV care and prevention depends on international aid, while South Africa self-finances most of its HIV expenditures, according to US government figures.
BATTLE FOR LIFE Activists march through the streets of Durban, South Africa, during the 21st International Aids Conference in July 2016.