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Global AIDS report showed risks of abandoning progress

Last week, as U.S. lawmakers considered health and science funding priorities for the coming year, an international commission of scientists as well as others involved and affected by responses to the global HIV pandemic released a report on the promise that recent major advances against the disease have offered.

The report, in the leading medical journal Lancet in collaboration with the United Nations, noted that those advances against HIV globally, which have been led by the United States,  are a result of unprecedented scientific and humanitarian efforts  to find answers to this deadly infectious disease and then deliver evidence-based treatment and prevention  on a massive scale. The report also detailed, though, how the numbers of people who need treatment for the virus that leads to AIDS still exceeds the number being treated. The report emphasized that without an acceleration of the current momentum to treat and prevent more infections, instead of beating the disease, we will see it rebound.

{mosads}Yet on the same day that report was released, Sen. Bill Cassidy (R-La.), a member of the Senate committee that allocates funding for the National Institutes of health, specifically suggested cutting the budget for research on HIV.  The senator, who also is a physician, noted that the percent of funding dedicated to HIV research had gone unchanged in the last 20 years, while “clearly disease prevalence has changed dramatically.”   He is right, HIV prevalence has changed dramatically, but it is hard to understand his point. Twenty years ago, when deaths from AIDS were at their peak, an estimated 200,000 people lived with HIV in the United States.  Today, about 1.2 million do, about one in eight of them unaware of their infection, while about 50,000 new infections occur annually in this country. Worldwide, of the estimated 35 million people living with HIV, only about a third of them are receiving the treatment they need to keep their disease from progressing and reduce risks of transmission, and over the next year, more than 2 million more people will become infected.

While it is hard to see how Cassidy reached his conclusion that this would be an appropriate time to cut funding for AIDS research, he is far from alone in failing to understand and respond to the realities of this global  pandemic in 2015. While the numbers of people living with HIV has continued to grow worldwide, and the tools to fight the disease have become more targeted, effective and critical, domestic spending to fight HIV has seen little growth and Congress has left funding for the President’s Emergency Plan for AIDS Relief, the leader of the global response, at 2011 levels for each of the last three years.  This flat funding shortchanges our ability to realize the full potential gains that our investments have already delivered – to deliver treatment that prevents transmission of the virus from mothers to their babies, to develop medicines to better treat the more than three million children who are infected, to reach communities where rates of incidence and prevalence remain high, and to reduce rates of tuberculosis, a curable disease that flourishes in HIV-infected immuno-compromised people, making it the leading cause of HIV-related deaths worldwide, posing a global threat in increasingly drug-resistant forms which can be passed to HIV-uninfected people.

Congress has another chance to respond to the epidemic and to the information in the Lancet “Defeating AIDS, advancing global health” report this week, when the Senate considers its annual funding bill for global health responses. President Obama, in turn also has a chance to help them by setting long overdue targets for accelerated HIV prevention and treatment efforts during the coming year. With that continued momentum, we can edge closer to the day when funding for HIV research can be cut, because it is no longer needed.

Mayer is Infectious Disease Attending physician and director of Prevention Research at Beth Israel Deaconess Medical Center; Medical Research director at The Fenway Institute; and co-chair of IDSA Center for Global Health Policy.


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