In May of 2009, President Barack Obama proposed a new Global Health Initiative to combat AIDS in some of the world's poorest countries. The plan proposed spending $51 billion on PEPFAR, the government global AIDS program. This is $5 billion less than what was promised in the 2008 Lantos-Hyde Act, disappointing many activists. Despite the drop in funding, however, there are still ways to work efficiently and provide AIDS services.
One way to do more with less funding is to redirect current prevention funds to areas in greater need, and to programs that are proven to work. In one promising example, the 2008 reauthorization of PEPFAR greatly relaxed restrictions on sexual education. Under President Bush, although one-third of prevention funds could be used on "condoms and related activities," any program that received PEPFAR funding was required to promote abstinence until marriage. Under this administration's new guidelines, if over half of an organization's programs teach about condoms, that organization can file a request for approval with an explanation. These requests, however, can sometimes be denied.
On the positive side, the reauthorization also proposed funding for the prevention of HIV among men who have sex with men and commercial sex workers, two groups disproportionately affected by HIV but largely ignored in the first few years of PEPFAR. This will enable organizations to spend money on two historically ignored high-risk groups, making the fight against HIV much more effective. PEPFAR funding can also now be used on needle exchange programs. Research has proven that clean needles drastically lower rates of both HIV and drug use.
One of the best ways to reduce spending on HIV treatment is to purchase generic medications. Although these were not widely available in the early years of AIDS, the landscape has changed dramatically in the past decade. Due to competition between generic manufacturers, HIV medications are now available for much lower prices. Nevertheless, even these reduced prices are still too high for many people in developing countries. The Global Fund and PEPFAR can help lower these costs even more by negotiating directly with manufacturers. In recent years, the Clinton Health Access Initiative has had success in negotiating with Pfizer to cut their prices for AIDS medications by 60%.
Organizations on the ground can also reduce their costs. By shifting tasks to local centers, the costs of medication delivery and overhead can be cut. Fewer trips to conferences and thoughtful use of technical assistance to improve the quality and efficiency of services can redirect valuable funds to direct care for patients. Informative studies and reports should be sent only to organizations that will use them (since printing and mailing costs can be high), and agencies should not overproduce these materials. New funders should be discouraged from creating "new" organizations from scratch -- they should instead donate to existing efforts.
Other measures that cost little or no money can make AIDS spending much more efficient. Male circumcision, which reduces transmission of HIV by over 50%, can be encouraged. Health care providers can also investigate maternal care and birthing practices to make sure that precautions are used, such as washing hands, using gloves, and using a birthing assistant. This is crucial to ensuring that mothers and children are kept safe from HIV and receive proper HIV treatment when needed. With needle exchange now eligible for funding, organizations should make sure that patients are made aware of these programs and helped to take advantage of them.
One of the most important ways to cut costs for HIV care, and keep patients healthy, is to have testing readily available. When HIV is caught early, treatment can be less expensive and more likely to keep people healthy longer. Organizations should make sure that HIV testing is available, for both children and adults, at routine doctors' visits.
Treatment programs are also one of the best ways to prevent transmission, since people who are on HIV treatment are 92% less likely to transmit HIV to their partner. Educating patients about the importance of family support, and implementing programs that reduce gay stigma and HIV stigma, are vital. When lesbian, gay, bisexual and transgender people feel supported by family and peers, they are less likely to engage in behavior that puts them at risk of HIV. People living with HIV are significantly more likely to stay on treatment and to practice self-care if they feel they are supported.
Above all, it is important to think creatively about bringing limited resources to those who need them most. A drop in funding is never great news, but with the right planning and restructuring, it can be an opportunity to refocus our efforts in the fight against AIDS.