Trump cuts will retard AIDS fight
• Experts warn before Paris conference of dire consequences globally if US Congress passes the president’s proposed budget
Progress in beating back the HIV/AIDS epidemic risks being eroded by a funding shortfall set to grow under US President Donald Trump’s proposed cuts to global health projects, experts and campaigners warn ahead of a major HIV/AIDS conference.
If adopted by Congress, the 2018 Trump budget could deprive 830,000 people, mostly in Africa, of life-saving anti-AIDS drugs, according to calculations by the Kaiser Family Foundation, a health policy nongovernmental organisation.
“We will see lives needlessly being lost,” said Linda-Gail Bekker, president of the International AIDS Society hosting about 6,000 experts in Paris from Sunday to take stock of advances in HIV/AIDS science.
“We’re not talking about a slowing down … if these [US] cuts come about we could very well see a real turnaround in terms of the progress that has been made,” she said.
A Trump budget could lead to nearly 200,000 new HIV infections, says the foundation.
It could also leave 25-million couples without access to sponsored contraceptives.
“I cannot tell you how anxious I feel.… To have the funding carpet taken from under our feet just seems such an incredible travesty,” said Bekker.
The US for years has been the biggest contributor to the global fight against HIV infection, accounting for about two-thirds of funding by governments.
In 2016, the US contributed $4.9bn to global HIV/AIDS projects — 7.5 times the sum provided by the second-biggest donor, Britain.
Trump’s proposed budget, submitted in May, would reduce this amount by about $1bn, according to activist group Health Global Access Project.
The US president put forward a blueprint which, in its own words, “reduces funding for several global health programmes, including HIV/AIDS, with the expectation that other donors can and should increase their commitments”.
The draft spending plan proposes to “maintain current commitments and all current patient levels on HIV/AIDS treatment” under the President’s Emergency Plan for AIDS Relief (Pepfar). The programme provides antiretroviral treatment to more than 12-million people.
Pepfar’s goal, said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, a US government research agency, “is to get more people who have been newly infected on therapy” — which means more money.
“If you don’t increase it, you … have more responsibilities that you are not able to meet.”
Trump also proposed a 17% cut of $222m to the US’s 2017 contribution of $1.13bn to the Global Fund to Fight AIDS, Tuberculosis & Malaria, which provides antiretrovirals to about 10-million people.
“The future outlook of donor funding for HIV remains uncertain, given recently proposed cuts … by the US, amid other competing demands on donor budgets more generally,” said the Kaiser foundation report.
Since the epidemic erupted in the 1980s, 76.1-million people have been infected with HIV. About 35-million have died. AIDS killed 1-million people in 2016 and HIV infected another 1.8-million, says the UN.
While infections and deaths are on the decline, the number of people living with HIV continues to grow. In 2016 of the 36.7-million people who needed antiretroviral treatment, had access to it.
By 2020, the UN is aiming for 90% of HIV-infected people to be on medication. But to achieve 19.5million this target, annual spending must reach $26.2bn, according to Unaids.
In 2016, public and private funders were able to muster $19.1bn for HIV/AIDS research, prevention and treatment programmes in poor and middleincome countries.
“We are maximising the use of every dollar available, but we are still $7bn short,” Unaids executive director Michel Sidibe said last week.
The conference organisers warned that “all of the scientific challenges still before us are threatened by a weakening resolve to fund HIV science”. The gap is set to grow larger.
“It is … a difficult moment,” said French HIV/AIDS expert Jean-Francois Delfraissy, cochair of the Paris meeting, citing
IF YOU DON’T INCREASE IT, YOU HAVE MORE RESPONSIBILITIES THAT YOU ARE NOT ABLE TO MEET
a “modification in US funding” and a shift in “the political vision of the US government” on working with other countries.
Just more than half of HIV/ AIDS-related spending came from domestic sources in 2016, but many poor countries rely heavily on foreign help.
Globally, said the Kaiser Foundation, government donor funding dropped in 2016 to the lowest level since 2010 — from $7.5bn to $7bn.
“We’ve seen two successive years of declines,” said Jen Kates, the foundation’s HIV/AIDS policy director. “This raises concerns about the ability of the global community to successfully tackle the epidemic.”