The United States spends $22 billion a year domestically on prevention and treatment of AIDS, and $6.6 billion a year on AIDS-related activities overseas. At the 19th International AIDS Conference on Monday, powerful figures said it's money well spent — but an insufficient sum to end the epidemic.
WASHINGTON — Some of Washington’s most powerful people delivered to the 19th International AIDS Conference pretty much the same message: Fighting AIDS is a good investment that is getting better every year, but current spending isn’t enough to end the epidemic.
Whether the world’s richer countries, and especially the United States, will decide to increase spending or alternatively wring more from current investment is a matter of much discussion among the 25,000 researchers, clinicians and activists meeting through Friday.
The United States spends $22 billion a year domestically on prevention and treatment of AIDS, up $2.5 billion since the start of the Obama administration. It spends $6.6 billion a year on AIDS-related activities overseas — more than six times total U.S. spending on global health in 2000.
All told, $17 billion is spent annually on AIDS in the developing world, where 8 million people are on life-extending antiretroviral drugs. To get 15 million people on those drugs by 2015 — the current goal — donor and recipient countries together will have to come up with $24 billion a year.
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“Why can we continue to pour $100 billion a year into Afghanistan, but we can’t find a quarter of that to end a global pandemic?” Sen. John Kerry, D-Mass., asked in one session. “This is precisely the moment we need to invest more, so that past investments are not lost and we don’t slide back.”
Sen. Lindsey Graham, R-S.C., noted that Congress’ appropriation for HIV/AIDS this year exceeded President Obama’s request. “To the American taxpayer, your money is going to a good cause,” he said.
Graham praised George W. Bush, whose President’s Emergency Plan for AIDS Relief (PEPFAR) launched this country’s big-ticket international AIDS spending in 2003. Of such far-flung spending, he said, “It’s OK for Republicans to get involved in this. This is a worthy cause for both parties.”
Secretary of State Hillary Rodham Clinton got a standing ovation when she addressed 7,000 people in the conference center’s largest hall in a morning session.
She reinforced her call last November for an “AIDS-free generation” — a phrase that’s becoming a battle cry. She described it as a time when there would be no child born with the virus, young adults would have a significantly lower risk of becoming infected and life-extending antiretroviral treatment would be available for anyone who needs it.
“HIV may be with us into the future until we finally achieve a cure and a vaccine, but the disease that HIV causes need not be with us,” she said.
She said three interventions will be necessary:
• Antiretroviral drugs need to be used much more widely so that infected people have little chance of transmitting HIV to others — so-called “treatment as prevention.”
• Circumcision, which reduces female-to-male transmission, must be practiced more widely.
• All pregnant HIV-infected women need to be treated with antiretrovirals to protect their babies during birth and breast-feeding.
She said the United States has spent $1 billion in recent years to prevent mother-to-child transmission, and that $80 million more will be spent to bring infected pregnant women into long-term care. Clinton also urged world leaders to address government corruption in the procurement and delivery of drugs, to protect sex workers and injection drug users, and to work toward paying for the AIDS response in their own countries.
In one session, philanthropist and Microsoft co-founder Bill Gates chatted with a group of people that included Jim Yong Kim, a physician who just assumed the presidency of the World Bank, and Eric Goosby, a physician who heads PEPFAR.
Gates disputed the assertion by many people that the tools for ending the epidemic already exist. The main one lacking is a vaccine, but also important and missing are woman-controlled means to prevent infection, such as a vaginal microbicide.
“No one should think that we have the tools yet. But we will have the tools if we stay the course,” he said. He described some of the Bill & Melinda Gates Foundation’s recent investments to fight AIDS, which have totaled $4 billion.