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AIDS money is flowing, but unevenly

Kai Ryssdal Aug 1, 2008

AIDS money is flowing, but unevenly

Kai Ryssdal Aug 1, 2008


KAI RYSSDAL: The United Nations AIDS program reported some good news this week. Fewer people are dying of the disease, and more patients are getting medication to treat HIV. Still, the U.N. said countries ought to keep on setting money aside for treatment and prevention. Funding’s going to be one of the big issues at the International AIDS Conference that kicks off this Sunday in Mexico City.

Science magazine correspondent Jon Cohen will be there. He’s written a series of stories on HIV/AIDS funding for the magazine. Mr. Cohen, good to have you with us.

JON COHEN: Thanks so much for having me.

KAI RYSSDAL: How much are we spending now on AIDS prevention and treatment globablly, versus, say, 10 years ago?

COHEN: If you combine all the money spent by middle- and low-income countries, and all the donations that come from wealthy countries, it’s about $10 billion a year. A decade ago that was about $450 million. So it’s jumped about 20-fold.

RYSSDAL: Well, why that huge increase?

COHEN: The huge increase was triggered by lots of factors. But I think the principle thing is that drugs started to work. By 1996 a lot of these drugs started to come to market. They just weren’t available to most of the world. Because most of the HIV-infected people in the world live in poor countries. And then, in 2000, the International Aids Conference was held in Durbin [South Africa], and that was the first time it was ever held in Africa — really at the epicenter of the epidemic. And, the fact that the meeting was held there just catalyzed this outcry that this great injustice was happening. After that meeting, several new mechanisms came about, plus the generic drug industry came forward very aggressively and said, “We can make these drugs and we’re going to do it.”

RYSSDAL: Tell me about those mechanisms. Where is the money coming from?

COHEN: There are four players with really deep pockets. One is a global fund to fight AIDS, tuberculosis and malaria. Another is the U.S. President’s Emergency Plan for AIDS Relief — PEPFAR. The World Bank is a huge contributor. And the fourth one is the Gates Foundation.

RYSSDAL: What’s the mechanism, though. Are they outright grants? Do you have to go through governments? How do you do it?

COHEN: Each one of these programs is very different. PEPFAR goes into a country, puts people on the ground, sets things up and delivers treatment and prevention campaigns and prevention efforts. The global funding contrast wants countries to do it on their own. They want to build local capacity. These are grants. It is, essentially, free money. The World Bank does both credits and grants. The Gates Foundation has put about $2 billion into HIV-AIDS research, treatment, prevention. So it dwarfs every other foundation in terms of its giving.

RYSSDAL: I wanted to ask you about distribution. And let’s just take, for example, Africa, since that’s where so much need is. Are the countries who need global AIDS money getting it?

COHEN: I looked at the hardest hit countries in the world, which are all in sub-Saharan Africa. And I asked the question: “How many dollars have been disbursed to them, and how many dollars have been committed, and how many HIV-infected people do they have?” And what I found were there were great disparities. So, there are some extremely hard-hit countries — Zimbabwe, for example — are in political turmoil, that have a hard time writing good grants that the U.S. government doesn’t want to give money to, that really aren’t getting much aid at all. And then there are other countries, like Ethiopia, which has more committed money than any country in the world, which in the relative sense doesn’t have as bad of an epidemic as many other countries.

RYSSDAL: What’s the answer, then. With this amount of money on the line — and, obviously, the social costs and risks — what’s the policy prescription for fixing global AIDS foundation money?

COHEN: There is no global architecture for health. One potential solution is to find ways to help these fragile countries write better grant proposals.

RYSSDAL: Kinda funny that AIDS relief comes down to your ability to do the paperwork.

COHEN: And it also comes down to donor darlings. You know, everybody likes to think that foreign aid is somehow equally distributed. Well, it’s not. It’s always tied up with politics when it’s bilateral.

RYSSDAL: Jon Cohen did the reporting for the pieces in the special issue on AIDS-HIV funding. It’s in Science magazine. Mr. Cohen, thanks a lot for your time.

COHEN: Thanks so much, Kai.

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