HIV prevalence strongly linked to poor progress on Millenium Development health goals

Slower progress towards achieving Millenium Development Goals on health is strongly correlated with a country’s burden of HIV disease and non-communicable diseases, according to an analysis by researchers from the London School of Hygiene, Oxford University and the University of California San Francisco published today in PLoS Medicine.

The Millenium Development Goals (MDGs) on health were set in 2001, and commit United Nations member states to work towards reducing child mortality by two-thirds and maternal mortality ratios by three-quarters, and to halt and reverse the spread of HIV, tuberculosis and malaria by 2015.

However progress has been uneven, and several explanations have been offered as to why low-income countries in particular have made such limited progress towards the health targets established in the MDGs. Limited resources and inadequate funding for health are commonly offered as explanations, along with the inadequate health infrastructure in many low-income countries.

Less attention has been paid to quantifying the impact of coexisting epidemics and non-communicable diseases, say the authors of the new study. Indeed, allocation of large amounts of donor funding to combat HIV has been specifically cited as a barrier to achieving MDGs on child and maternal mortality, since this is accused of diverting funds away from interventions argued to have greater population impacts.

The analysis published this week in PLoS Medicine shows that, if anything, it is inadequate responses to AIDS that are impeding progress towards MDG health targets, along with a failure to appreciate the extent to which HIV and non-communicable diseases trap households in cycles of poverty and illness.

The study, carried out by Dr David Stuckler at Oxford University, Professor Martin McKee at the London School of Hygiene and Tropical Medicine, and Dr Sanjay Basu at the University of California San Francisco, is an analysis of Millenium Development Goal indicator reports, in which the researchers looked at the relationship between the rate of progress towards the health MDGs and the following variables:

• Economic development (measured as GDP per capita)
• Priority placed on health (health spending as a percentage of GDP)
• Real health spending
• HIV/AIDS burden
• Non-communicable disease mortality rates.

The analysis found that national burdens of HIV/AIDS and non-communicable diseases explained more than half of the inequalities between countries in progress on child mortality and TB control.

Indeed, the relationship was so strong that reducing HIV prevalence by just 1% would have a similar impact on progress towards the tuberculosis MDG as one decade of economic growth in a low-income country (a GDP increase of at least 80%), the researchers say. Reducing HIV prevalence by 1% would have a similar effect on child health outcomes as a 40% increase in GDP over ten years, they say.

In contrast GDP per capita, health spending as a proportion of GDP, total health spending and physicians per capita explained no more than one-fifth of the total difference between countries making good progress and countries making poorer progress.

Global health initiatives need to embrace a wider range of health problems, the researchers argue, and narrowing of focus – either to emphasise one specific disease, or one specific outcome, such as immunisation uptake – may lead policy makers to ignore the interrelationship between diseases which “trap households in vicious cycles of mortality and poverty.”