San Francisco Chronicle - Wednesday, May 14, 2003
Sabin Russell, Chronicle Medical Writer

The study released by the Global HIV Prevention Working Group on Tuesday warned that only 1 in 5 people at risk for AIDS has access to AIDS prevention programs. It called for a tripling of global spending on AIDS prevention alone, to $5.7 billion by 2005, from $1.9 billion last year.

"Global access to prevention is severely limited," warned Dr. Helene Gayle, director of HIV programs at the Bill and Melinda Gates Foundation, which co- sponsored the study.

The report focuses on programs to prevent AIDS, rather than those that treat it. Advocates for prevention are often scrambling for the same limited dollars as advocates for treatment, but the two sides agree that both treatment and prevention are indispensable for controlling the epidemic.

Properly funded, Gayle said, prevention programs could stave off 29 million of the projected 45 million new HIV infections forecast by 2010. "There is a lot of potential and hope for averting this if we scale up prevention efforts, " she said in a telephone news conference.

There are currently 42 million people infected with HIV, the virus that causes AIDS, according to the Joint United Nations Program on HIV/AIDS (UNAIDS). The epidemic has already claimed 24 million lives, including 3.1 million in 2002.

The working group, co-sponsored by Menlo Park's Kaiser Family Foundation, identified regional shortfalls in HIV prevention spending. In sub-Saharan Africa, for example, spending on prevention programs should be boosted by $573 million annually, to $1.5 billion, by 2005, according to the report.

In Asia, where epidemiologists fear an explosive increase in HIV, the annual spending gap was pegged at $1.48 billion. The goal is $1.9 billion by 2005.

Contrary to common perception, the working group noted, poor countries spent more of their own money on AIDS prevention programs last year than they received in contributions from wealthier governments for such efforts.

In 2002, developing nations spent $782 million on AIDS prevention efforts, while wealthy governments provided $780 million to them for similar programs.

Private foundations and other charitable groups contributed $160 million, while U.N. agencies distributed $100 million.

Kaiser Family Foundation President Drew Altman said foundations needed to do more. "The charitable response is anemic, at best," he said.

Wealthy nations are also failing to pay their fair share, Altman suggested.

The Kaiser foundation alone, he noted, contributes more to HIV prevention programs annually than the governments of Sweden or France. "The amounts given for prevention by many wealthy donor nations, I would characterize as quite small," Altman said. "They look more like what you'd expect from a foundation than a major country."

The Bush plan, which comes up for a Senate vote Thursday, would authorize spending of up to $3 billion per year for five years on a variety of international AIDS prevention and treatment programs, most of it going to 14 African and Caribbean nations.

A version of the bill passed in the House of Representatives contains provisions designed to encourage more AIDS contributions from wealthy countries. It calls for the U.S. annual contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria to grow to up to $1 billion per year if it is matched by contributions from other donor nations, at a rate of $2 for every dollar from the United States.

Due to inadequately funded prevention programs, advocates contend, just 5 percent of pregnant women at risk for AIDS have access to antiviral drugs that can sharply reduce transmission of HIV to their newborns.

Condoms, the oldest and perhaps most effective weapon against AIDS, are available to only 42 percent of the world population deemed at risk for the disease. In Africa alone, there is a condom shortage estimated at 1.9 billion annually. Condom donation programs provide the equivalent of three per year for every adult male in Sub-Saharan Africa.

AIDS prevention efforts must also address the reuse of unsterile syringes in health care settings, which the WHO acknowledges is responsible for 80,000 infections annually in sub-Saharan Africa. The report estimates that only 20 percent of medical injections are safe, and calls for "rapid scale-up of infection control and safe injection practices in the region."

E-mail Sabin Russell at srussell@sfchronicle.com.

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