Newsday - June 22, 2001
Laurie Garrett, Staff Writer

A team of scientists and economists, working at the behest of the United Nations AIDS Programme in Geneva, has developed a strategy for conquering AIDS, and priced out each component. The report's release was clearly timed to precede next week's UN General Assembly Special Session on AIDS, in which 198 countries will debate how to tackle what is becoming the largest epidemic in human history.

The study "gives us a global plan, targeted time line, and a major instrument for creating accountability," said Dr. Peter Piot, executive director of UNAIDS, in a teleconference yesterday from Geneva.

The UNAIDS team, led by Dr. Bernard Schwartlander, the agency's chief epidemiologist, sought to determine what it would take, country by country, to slow the spread of HIV, and what resources each country had. Where resources were lacking, the team explored who might supply them.

The result is a sort of fiscal manifesto for global AIDS. Current total spending on AIDS, according to UNAIDS, is $1.8 billion, gleaned from wealthy and poor countries, private donors and some companies. The report finds that spending level needs to increase yearly, from $3.2 billion in 2002 until a peak in 2005, reaching $9.2 billion a year. That level must, at a minimum, be maintained thereafter, the report states.

Those 2005 dollars should be apportioned as follows: $4.8 billion a year for prevention efforts, and $4.4 billion annually to treat the sick and offer support to their families and orphans. But that distribution would vary regionally, Schwartlander explained. In areas such as South Asia and the former Soviet Union, where the epidemic is still in early stages, the balance of expenditures should tip heavily on the side of prevention. In sub-Saharan Africa, however, where about 25 million are already infected, the goal should be to have half of those with symptoms in treatment, using antiretroviral drugs. That would tip the spending balance for Africa heavily to the side of treatment.

For preventing further spread of HIV, the report envisions spending money to purchase 6 billion condoms a year worldwide; give prenatal HIV screening to 35 million pregnant women annually and treatment to 900,000 of them to prevent passage of HIV to their babies; distribute sterile syringes and drug rehabilitation information to 3 million IV drug users, and conduct outreach programs to the 6 million people working in the sex industry worldwide.

Treatment would focus on preventing opportunistic infections, such as tuberculosis and malaria, in HIV-positive people. About a quarter of the treatment dollars would be spent on purchasing and distributing antiretroviral drugs for people with AIDS.

"We estimate that in much of Asia and Latin America, the majority of the funds will come from domestic resources," Piot said. But, he added, "that leaves us short several billion dollars."

The report details every likely source of funds, including about $100 million the very poorest nations in the world would be asked to contribute, in the form of forgiven debts. Even beleaguered African countries would be expected to meet 20 percent of their AIDS control needs, and middle income countries such as Brazil would generate 80 percent.

The United States currently spends $20 billion a year on domestic AIDS programs, including research, treatment and prevention, but less than $400 million on overseas HIV efforts.

The Science report today predicts that for the world to meet its $9.2-billion target, the United States, Western Europe, Canada and Japan would have to increase their annual overseas support by 7 percent to 10 percent, at a minimum, each year.

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