Any other group of activists might be in a mood to celebrate. The HIV-AIDS lobby has been among the most successful in the world, winning an impressive $10 billion in new annual funds and tripling the level of global support for AIDS programs since 2003.
Instead, AIDS advocacy groups are in a state of anxiety. Their future is looking increasingly difficult, despite all their recent gains.
The global economic crisis is jeopardizing support from governments and other donors, even as the funding gap is widening and new studies suggest that a huge increase in spending will be needed if they want to have any hope of defeating the AIDS epidemic.
At the same time, the activists are facing a new threat: a backlash from academic researchers who suggest AIDS is actually getting too much money -- or at least more than its fair share of the global health pie.
At the conference of the International AIDS Society in Cape Town this week, attended by 5,000 scientists and delegates, the activists were on the defensive. While they argued for billions of dollars in new financing, they also felt obliged to respond to a small coterie of academics who question the high percentage of health funds devoted to AIDS.
A new study in the medical journal The Lancet, published last month, found that AIDS is getting 23 percent of all international health financing in poor countries around the world, even though AIDS is responsible for less than 4 percent of global deaths.
Economists and health researchers such as William Easterly and Roger England are arguing that too much money is spent on AIDS, crowding out other health priorities that could save more lives at lower cost.
Easterly, an economist at New York University, notes that AIDS received 57 percent of World Bank projects on communicable disease, compared to 3 percent for malaria and 2 percent for tuberculosis, even though the AIDS projects achieved worse results than the other health projects. He said this was "irrational behavior" by the bank for "purely political reasons."
At the conference in Cape Town, AIDS activists joined other health advocates to forge a united front against the critics. Gorik Ooms, a director of the Global AIDS Alliance, said the academic debate is becoming an excuse for the wealthy governments of the G8 to abandon their pledge of universal access to AIDS treatment by 2010.
Pat Daoust, a health campaigner at Physicians for Human Rights, said she was disturbed by the critical article in The Lancet, especially when she realized that one of its authors had been appointed as an adviser to President Obama's administration. "When I read that article, my blood pressure was going up with every sentence," she said. "Articles of that nature begin to pit one area of health against another."
Canadian AIDS campaigner Stephen Lewis, the former U.N. envoy on HIV-AIDS in Africa, launched a sharp attack on the academic critics this week. The detractors are "driven by resentment at the success of the AIDS movement," he said in a keynote speech to the conference in Cape Town. "These arithmetic arguments alleging that AIDS is getting too much money at the expense of other health imperatives ... this is simply naked academic and bureaucratic envy," Lewis told the scientists.
"You should find a way, collectively, to shoot down the pinched bureaucrats and publicity-seeking academics who advocate exchanging the health of some for the health of others," he said.
"We're talking about human lives, for God's sake, not about the phony parsing of balance sheets. Rather than asking for more money, they have this punitive spasm to ransack resources for AIDS. You must not let them get away with it."
Instead of dividing the health budget in a different way, the critics should lobby for much greater health spending in total, so that all needs can be met, Lewis said. "We have to fight the good fight for enlarging the pie, or everyone loses."
There is a growing consensus at the AIDS conference that global spending must be much higher so treatment can begin at an earlier stage of infection. Mounting scientific evidence suggests there are major health benefits to starting treatment earlier, the conference has been told.
But the conference was also told of major inefficiencies in the current system of AIDS funding. One study, for example, noted that the global spending on AIDS has climbed to about 60 percent of the recommended level for covering everyone in the developing world who needs treatment -- yet only about 30 percent of those with the virus are actually receiving treatment. This suggests "serious inefficiency" in the AIDS programs, the study said.
(Distributed by Scripps Howard News Service, www.scrippsnews.com.)
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