At a time when the global commitment to fund anti-AIDS programs is flagging, the administration of US President Donald Trump is proposing in its 2018 budget to cut hundreds of millions of dollars from programs such as the President's Emergency Plan For AIDS Relief, which has saved millions of lives in Africa and other areas.
Health care professionals at an international AIDS/HIV conference in Amsterdam last week said PEPFAR, as the plan is called, would be hard hit, as would other bilateral programs which would lose up to US$880 million, according to advocates. The US contribution to the Global Fund to Fight AIDS, TB & Malaria would be cut by US$225 million. USAID and other programs would see cuts including for malaria (44 percent), tuberculosis (26 percent), and maternal and child health (8 percent).
“There can be no progress without action, and our ability to act is attenuated if much-needed funding is jeopardized,” said José M Zuniga, the president of the International Association of Providers of AIDS Care, “The 90:90:90 targets (to have 90 percent of people living with HIV aware of their HIV status by 2020, with 90 percent of those diagnosed HIV infection receiving antiretroviral therapy and 90 percent receiving antiretroviral therapy having viral suppression by 2020).and the goal to end AIDS by 2030, can be achieved.
But, Zuniga said, under the Trump Administration's 2018 budget proposals, global health funding for programs, such as PEPFAR, would be hard hit. The administration has already been diverting funds from health programs to defray the costs of caring for children separated from their families in President Trump’s so-called “zero tolerance” immigration policy. The cuts started when the Administration for Children and Families (ACF) started funding this effort with money left over from an HIV/AIDS program.
Global new HIV infections have declined by only 18 percent in the past seven years: from 2.2 million in 2010 to 1.8 million in 2017, according to Ishwar Gilada, President of the AIDS Society of India (ASI), and among the first doctors who began HIV care in India when first case got diagnosed in the country.
“If business as usual continues, then we will fail to reach the target of fewer than 500,000 new HIV infections per year by 2020," Giolada warned. “Although tremendous progress against AIDS over the past 15 years has inspired a global commitment to end the epidemic by 2030, we cannot afford to slacken HIV prevention or delay provision of anti-retroviral therapy to every person living with and monitor viral load.”
Of the 36.9 million people living with HIV globally today, Gilada said, 21.7 million of them were on antiretroviral therapy by 2017. New HIV infections have been reduced by 47 percent since the peak in 1996. But, he said, IDS-related deaths have been reduced by more than 51% since the peak in 2004.
In 2017, 940 000 people died from AIDS-related illnesses worldwide, compared to 1.9 million in 2004 and 1.4 million in 2010.
PEPFAR, the president’s emergency aids program, remains arguably George W Bush’s most important legacy in an otherwise benighted presidential career. The program, suggested to Bush by adviser Condoleeza Rice, brought together companies, foreign governments and investments by partners in 2003 to address the HIV/AIDS pandemic, which at that point threatened to wipe out an entire generation in Africa. Nearly 12 million lives have been saved and nearly 2 million babies have been born HIV-free to infected mothers, according to the World Health Organization.
Without the US commitment, the danger of a return of the disease, the world’s worst pandemic, will grow, health professionals told the Amsterdam conference.
“Despite recent improvements in accessing HIV treatment and care in the region, the response to the HIV epidemic still faces many challenges,” said Jürgen Rockstroh of the University of Bonn and a governing council member of the International AIDS Society. “Only 28 percent of the people living with HIV in Eastern Europe and central Asia were reported to be receiving HIV treatment in 2016, far below the western and central Europe average of 76 percent and the global average of 53 percent.
That.Rockstroh said, indicates an alarming situation in the region as a whole to move towards achieving these targets. “Furthermore, about half of the people diagnosed with HIV are diagnosed at late stages and lifesaving treatment gets delayed. Many people living with HIV thus start treatment too late and already show signs of widespread immune system damage, leading to excess morbidity and mortality. New action plans are needed to achieve a breakthrough.”
Can we afford to slow the momentum against AIDS?
R Sajith Kumar, Governing Council member of AIDS Society of India (ASI) said, “India boasts of an efficient public private partnership with a large proportion of patients under dual care as well. Almost 50 percent of HIV-infected people are diagnosed by private practitioners, though many of them subsequently go to the government for further care. ASI plays a great role by bringing both groups together under one academic entity. Viral load monitoring and resistance studies that have been extensively promoted by ASI, will contribute to progress towards achieving the 90:90:90 target that is part of India’s National Health Policy 2017.”
Reflecting on the current scenario in India, RS Gupta, Deputy Director General of National AIDS Control Organization of Ministry of Health and Family Welfare, Government of India said that, “The good news is that incidence and prevalence of HIV has declined sharply, as a result of improved prevention, care, support and treatment.”
However he said, ”universal access of comprehensive healthcare services to all people living with HIV and reaching out to the hidden and unidentified populations remains a big challenge in achieving 90-90-90 by 2020 and eliminating HIV by 2030.
With additional reporting from Shobha Shukla, Managing Editor of Citizen News Service