A U.S. budget proposal to reduce foreign aid by one-third would
affect more than $6.7 billion currently earmarked for HIV/AIDs
research, prevention and treatment, researchers note in the Annals
of Internal Medicine, online August 28.
In South Africa alone, cutbacks could result in more than 500,000
additional cases of HIV and more than 1.6 million more deaths within
the next decade, researchers estimate.
At most, the proposed budget cuts would save just $600 to $900 for
every year of life lost in South Africa and the Ivory Coast,
researchers estimated, because any initial savings would lead to
high costs down the line to treat more people infected with HIV.
“This is not an epidemic we can kick down the road and think it will
go away,” said lead study author Dr. Rochelle Walensky, an
infectious disease researcher at Harvard Medical School and
Massachusetts General Hospital in Boston.
“Loss of investment now will mean bigger problems and price tags
later,” Walensky said by email.
To assess the potential impact of foreign-aid cuts on the global
effort to combat HIV, researchers compared current standards for
starting antiretroviral therapy and keeping people on the drugs to
what might occur with fewer resources.
Researchers looked at cost data from the Republic of South Africa
and the Ivory Coast to see what might happen in each country if HIV
screening was reduced, access to medication was limited to the
sickest patients, access to alternative drugs when initial
treatments don’t work was eliminated, and lab tests to monitor
patients and efforts to keep people in long-term treatment were cut
They estimated how much money could be saved by each of these moves,
how many new infections and deaths would occur, and how many
additional years of life would be lost.
Existing commitments to patients already receiving care for HIV
infection would restrict overall saving to no more than 30%, the
researchers estimated. As currently proposed, the U.S. foreign-aid
budget cuts would not reduce care for people already on treatment.
Over time, those savings would dry up, as the increase in HIV
transmissions would lead to accumulating costs for the care of those
patients, the researchers conclude.
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One limitation of the study is that researchers don’t know what
changes would actually be made to HIV prevention or treatment based
on the proposed U.S. foreign-aid cuts.
Even so, the analysis offers a preview of what could happen after
cutting back investment in HIV prevention and treatment, said Arleen
Leibowitz, a public policy researcher at the University of
California, Los Angeles, who wasn’t involved in the study.
“Early antiretroviral treatment has a double benefit - it improves
health and survival of the HIV-infected person, but also cuts down
on transmission,” Leibowitz said by email. “This, in turn, will
reduce long-run costs.”
When newly infected patients start antitretrovirals quickly, they
can become non-contagious within two to three months, noted Dr. Eric
Goosby of the University of California, San Francisco School of
“The drop in the number of infections creates less utilization of
clinics, emergency services and inpatient service, thereby saving
money,” Goosby, who wasn’t involved in the study, said by email.
Cutting back in HIV investments now would reverse extraordinary
gains made in saving lives and reducing new HIV infections, said Dr.
Diane Havlir, chair of the UNAIDS Science and Technology Advisory
“Such pullbacks would ensure we would pass on HIV epidemic for
generations to come,” Havlir, who wasn’t involved in the study, said
Ann Intern Med 2017.
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