Roger England argues in a recent BMJ article that we spend more money on HIV/AIDS programs than the contribution of AIDS to the global burden of disease can justify. Predictably there have been some vehement and high profile responses to his article.
In short England argues that too much is spenton HIV relative to other needs and that this is damaging healthsystems. Although HIV causes 3.7% of global mortality, he argues, itreceives 25% of international health care aid and a big chunkof domestic expenditure.
England argues further that Aids does not correlate with poverty as closely as expected. If this is true, it would mean that more people with AIDS can contribute to their own health care needs than we think.
Some of the key responses to England have been:
- Underfunding of other diseases is the result of global underspending on Health, not the result of prioritizing AIDS
- AIDS has its most devastating effects in poor communities that lack access to health services
- In regions like Southern Africa, the burden of disease associated with AIDS does justify what is spent on it
- The spread of AIDS is silent and the long incubation period means the virus has infected many people before illnesses manifest and the threat is apparent. As a result we don’t know at what level incidence will peak.
- Donor conditionalities do not allow poor countries to prioritize health spending based on their own burden of disease.
This debate raises some key points. It seems clear that:
- This question should not just be asked of ‘global health spending’, but also of the health spending in each country
- Most poor countries do not spend enough money on health
- Donor conditionalities sometimes do distort health spending in recipient countries
- We have no way of knowing what the potential contribution of HIV/AIDS to the global burden of disease is.
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