Vienna — Speaking at the International AIDS Conference earlier this week, former US President Bill Clinton told delegates that the credit crunch meant HIV programmes would need to work "faster, better and cheaper".
IRIN/PlusNews has put together a list of ways HIV service providers could cut costs and improve their efficiency:
Task-shifting - The allocation of tasks traditionally performed by doctors and nurses to less qualified staff has already seen positive results in Ethiopia, Malawi and Mozambique.
There will be a need to carefully monitor task-shifting programmes and ensure proper training of health workers, as some studies have found that insufficiently trained medical staff can be harmful to national antiretroviral (ARV) programmes.
Community support - Community mobilization has already played a significant role in HIV education and care in many poor countries where relatives and neighbours often help to monitor patients and raise awareness about HIV. Research has found that community support improves adherence to ARV medication and that involving people living with HIV to serve as community health workers can cut costs and reduce stigma.
Cheaper drugs - The cost of combination ARV therapy has come down significantly from about US$10,000 per person per year in 2000 to about $88 a year. The Clinton Health Access Initiative, the US President's Emergency Plan for AIDS Relief (PEPFAR) and the international funding mechanism, UNITAID, have all contributed significantly to negotiating with pharmaceutical companies to lower drug prices.
However, the second- and third-line ARVs that are needed by increasing numbers of patients who have developed resistance to first-line drugs are still prohibitively expensive for low income countries. A recently created patent pool will be central to persuading big pharmaceutical companies to allow generics manufacturers to use their patents to produce such drugs more cheaply.
Simpler drug delivery systems - Speaking at the International AIDS Conference earlier this week, Bernhard Schwartlander, UNAIDS director for evidence, strategy and results, noted that between two-thirds and 80 percent of money spent on HIV is not drug-related - it is related to service delivery, patient monitoring, and laboratory costs.
More efficient drug procurement and supply chains would go a long way towards making programmes more cost-effective and efficient. In Uganda, for instance, supply chain woes have left people without drugs, in some instances because ARVs were allowed to expire before being dispensed.
Using technology - SMS-based check-ups (using text messages sent from cell phones) are saving patients in Kenya the cost of travelling to a clinic every month, while a multi-country campaign in Africa is using cell phone technology to track stock-outs of essential medicines in government facilities.
Country ownership - Done properly, shifting the management of HIV programmes from foreign donors and NGOs to national governments would reduce administrative costs while giving locals the skills to sustain programmes. PEPFAR is already transferring the management of its programmes from the US Agency for International Development to local governments.
Fighting government graft will, however, be key to the success of country-run HIV programmes. Concerns over corruption have, for example, led the Global Fund to Fight AIDS, Tuberculosis and Malaria to cancel or suspend its funding to several countries.
Health system integration - Large investments in HIV have been criticized for drawing money and human resources away from under-funded national health systems.
Today, the global health community seems in agreement that integrating HIV into strengthened national health systems is a good idea. HIV service providers are being urged to work with other health services so that all sectors of the health system can benefit. In Haiti, for instance, voluntary counselling and testing services are providing a useful entry point for reaching women in need of sexual and reproductive health services.
[ This report does not necessarily reflect the views of the United Nations ]
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UNAIDS Head Michel Sidibe and Deputy President of South Africa Kgalema Motlanthe are very heavily promoting genital mutilation as HIV "prevention" and no one at the conference seems to be raising an eyebrow? Has the whole world gone MAD???
First of all, the VERY idea. Would the WHO, UNAIDS etc. ever recommend FEMALE circumcision as a way to curb AIDS, if it were shown in "studies" that it "might" prevent HIV transmission by 60%? What about 100%?
The answer is, no, they wouldn't. Forcefully circumcising a girl or woman would be immediately recognized as a basic human rights violation. When something is a basic human rights violation, it doesn't matter how many studies are written for it. All the "studies" in the world would not be enough to promote female circumcision. How is it that we have allowed this to happen with male circumcision?
Why can't researchers seem to focus on something else? What research is being done to move past circumcision? What studies are being made on alternative medicine? Usually, medicine tries to ABOLISH the use of surgery, not seek its preservation. This "lets circumcise everybody" idea is MADNESS. I'm surprised no opposition was raised at the conference.
But secondly, the claim that circumcision prevents HIV isn't entirely solid. There are a few realities that "researchers" have failed to explain.
In America, for example, 80% of men are already circumcised from birth. The rates of infant circumcision are dropping, but at large, the population remains circumcised. These rates are at their highest in the East Coast, where cities such as Philadelphia and Washington DC rival HIV hotspots in South Africa. In the 1980s, when the AIDS epidemic first hit, the rate of circumcised men in America was at 90%. One needs to question how something that never worked here in our own country is suddenly going to start working wonders in Africa.
In other countries, the "protection" remains to be seen as well. AIDS is a rising problem in Israel, where the majority of the male population is already circumcised. On Wednesday, July 7th, two weeks ago, Malaysian AIDS Council vice-president Datuk Zaman Khan announced that than 70% of the 87,710 HIV/AIDS sufferers in the country are Muslims (CIRCUMCISED). The Muslim population accounts for 70% of the incidence of HIV, but only 60% of the population, which would mean that the circumcised population is getting HIV at a much higher rate than the non-circumcised.
Millions are being spent on a "prevention method" with dubious benefits, when they could be spent on other modes of prevention that have been conclusively proven to work. Condoms and education for example. Some people say "that hasn't worked," but that's not the reality. Reports are coming in saying that AIDS/HIV is dropping in African youth, and this is due to BEHAVIORAL change.
Circumcision is going to COST more money in the long run. A recent issue of the WHO Bulletin noted that African ritual circumcisions have a 35% complication rate, while clinical circumcisions have an 18% complication rate. A neonatal circumcision complication rate of 20.2% was found in Nigeria. As you may know, Annie, funds for the fight against AIDS are scarce. Dealing with these complications is going to divert resources away from other more-needed programs, such as mother-to-child transmission reduction, and treatment of people who are already infected.
Not to mention that men are using their circumcisions as an excuse not to wear condoms, putting themselves and their partners in danger. That's MORE money, because now you have more people infected, and more people on drugs. But that's what this whole thing in Vienna was about, wasn't it; drugs.
Tribal groups are using the WHO's stance to go ahead with traditional circumcision rituals, where men, if they want to be called "real men," are ostracised if they want to go to a hospital to have a "safe" circumcision. 47 men have already died this year, and a lot more have lost their penises to gangrene.
This is already being used to carry out circumcisions in healthy, non-consenting CHILDREN. "Rights here, right now" was the slogan at this year's conference. Where is human rights HERE? How is it that circumcision is being pushed on children who aren't even sexually active and therefore at ZERO risk? Shouldn't circumcision be for those who WANT it, and they KNOW they're going to be engaging in risky behavior? Why are men being coerced in KwaZulu Natal? This is MADNESS.
This is an UNACCEPTABLE form of "prevention." Leaders need to find something else.
I cannot get behind a movement that endorses genital mutilation as "prevention." They'll just have to get their money and my signature for their precious "Vienna Declaration" from elsewhere. And I'm notifying all my friends too. As long as this madness continues, UNAIDS, UNICEF etc. should NOT be getting our money. This is absolute MADNESS.