More experts vocal about shifting money away from AIDS

LONDON - As World AIDS Day is marked on Monday, some experts are growing
more outspoken in complaining that AIDS is eating up funding at the expense
of more pressing health needs.

They argue that the world has entered a post-AIDS era in which the disease's
spread has largely been curbed in much of the world, Africa excepted.

"AIDS is a terrible humanitarian tragedy, but it's just one of many terrible
humanitarian tragedies," said Jeremy Shiffman, who studies health spending
at Syracuse University.

Roger England of Health Systems Workshop, a think tank based in the
Caribbean island of Grenada, goes further. He argues that UNAIDS, the U.N.
agency leading the fight against the disease, has outlived its purpose and
should be disbanded.

"The global HIV industry is too big and out of control. We have created a
monster with too many vested interests and reputations at stake, ... too
many relatively well paid HIV staff in affected countries, and too many rock
stars with AIDS support as a fashion accessory," he wrote in the British
Medical Journal in May.

Paul de Lay, a director at UNAIDS, disagrees. It's valid to question AIDS'
place in the world's priorities, he says, but insists the turnaround is very
recent and it would be wrong to think the epidemic is under control.

"We have an epidemic that has caused between 55 million and 60 million
infections," de Lay said. "To suddenly pull the rug out from underneath that
would be disastrous."

U.N. officials roughly estimate that about 33 million people worldwide have
HIV, the virus that causes AIDS. Scientists say infections peaked in the
late 1990s and are unlikely to spark big epidemics beyond Africa.

In developed countries, AIDS drugs have turned the once-fatal disease into a
manageable illness.

England argues that closing UNAIDS would free up its $200 million annual
budget for other health problems such as pneumonia, which kills more
children every year than AIDS, malaria and measles combined.

"By putting more money into AIDS, we are implicitly saying it's OK for more
kids to die of pneumonia," England said.

His comments touch on the bigger complaint: that AIDS hogs money and may
damage other health programs.

By 2006, AIDS funding accounted for 80 percent of all American aid for
health and population issues, according to the Global Health Council.

In Ethiopia, Rwanda, Uganda and elsewhere, donations for HIV projects
routinely outstrip the entire national health budgets.

'Gross misallocation of resources'
In a 2006 report, Rwandan officials noted a "gross misallocation of
resources" in health: $47 million went to HIV, $18 million went to malaria,
the country's biggest killer, and $1 million went to childhood illnesses.

"There needs to be a rational system for how to apportion scarce funds,"
said Helen Epstein, an AIDS expert who has consulted for UNICEF, the World
Bank, and others.

AIDS advocates say their projects do more than curb the virus; their efforts
strengthen other health programs by providing basic health services.

But across Africa, about 1.5 million doctors and nurses are still needed,
and hospitals regularly run out of basic medicines.

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Diarrhea kills more kids
Experts working on other health problems struggle to attract money and
attention when competing with AIDS.

"Diarrhea kills five times as many kids as AIDS," said John Oldfield,
executive vice president of Water Advocates, a Washington, D.C.-based
organization that promotes clean water and sanitation.

"Everybody talks about AIDS at cocktail parties," Oldfield said. "But nobody
wants to hear about diarrhea," he said.

These competing claims on public money are likely to grow louder as the
world financial meltdown threatens to deplete health dollars.

"We cannot afford, in this time of crisis, to squander our investments," Dr.
Margaret Chan, WHO's director-general, said in a recent statement.

Some experts ask whether it makes sense to have UNAIDS, WHO, UNICEF, the
World Bank, the Global Fund plus countless other AIDS organizations, all
serving the same cause.

"I do not want to see the cause of AIDS harmed," said Shiffman of Syracuse
University. But "For AIDS to crowd out other issues is ethically unjust."

De Lay argues that the solution is not to reshuffle resources but to boost
them.

"To take money away from AIDS and give it to diarrheal diseases or
onchocerciasis (river blindness) or leishmaniasis (disfiguring parasites)
doesn't make any sense," he said. "We'd just be doing a worse job in
everything else."