Expert panel maps global 'HIV prevention gap': $6 billion needed by 2007

A report released today with backing from UNAIDS and WHO spells out the gap between what could be done to control the global HIV epidemic and the resources available or promised to do so. The report, co-sponsored by two major US Foundations (Bill and Melinda Gates and the Kaiser Family Foundation) has been compiled by an international 40-member working group. It calls for global HIV prevention spending to be tripled from US $1.9 billion at present to $5.7 billion by 2005 and $6.6 billion by 2007. The bulk of this funding should come from wealthier countries as international development aid, which should be increased to 0.02 per cent of national income (GDP) for this purpose. At present, none of the donor countries meets this target. In addition, the report endorses the view that access to treatment and care needs to expand alongside HIV prevention.

The report quotes UNAIDS and WHO estimates that 29 million of the 45 million new HIV infections that are expected to happen between now and 2010 could be prevented, if well-tried current methods received the backing they need and deserve.

HIV prevention needs were assessed for developing countries, region by region, and compared to current levels of spending. Nearly half of what is being spent comes from the national resources of developing countries themselves. The extent of the gap varies around the world and is largest for Asia and the Pacific (US $1.48 billion), followed by Eastern Europe and Central Asia (US $1.18 billion), and then the Caribbean and Latin America (684 million). Current spending is highest in Sub-Saharan Africa, at $927 million, though even here spending needs to increase by more than 50%.

The report endorses the promotion of sexual abstinence, but not to the exclusion of other approaches. "There is no magic bullet to prevent the spread of HIV. Only a combination of approaches that addresses the needs of different populations at risk can be effective," said Working Group co-chair David Serwadda of Makerere University, Uganda. "In Uganda, we have brought a severe HIV epidemic under control through the use of combination prevention, including abstinence education, condom promotion, voluntary HIV counselling and testing, and STD control. Other nations must be supported in their efforts to introduce a wide range of science-based prevention interventions, tailored to the needs of their people."

Other recommended interventions include promoting reductions in the number of partners, tackling gender inequity, ARV use to prevent mother to child transmission (especially in Africa), blood safety and infection control in health care, support for people living with HIV, behaviour-change programmes for men who have sex with men, and harm-reduction programmes for injecting drug users (especially in Asia and Eastern Europe).

The US Congress is considering a Bill to give reality to President Bush's pledge to commit US $15 billion over three years to global HIV and AIDS. As previously reported here, this includes provisions requiring that one third of the HIV prevention element - which is 20 per cent of the total - should be committed to promoting abstinence and/or monogamy. The proposed US spending on HIV prevention would add up to $3 billion over 5 years, or $600 million a year. Of this, $200 million would therefore have to be spent on promoting abstinence and/or monogamy. If US HIV prevention spending rose to $600 million a year, this would still be less than ten per cent of the global need estimated in this report, although it could meet a higher proportion of the needs in the particular countries in which it is to be concentrated.