Universal Access to HIV/AIDS Treatment

The 21st century has witnessed unprecedented increases in funding for global health driven mainly by efforts to address the HIV/AIDS epidemic. The US Presidents Emergency Plan for AIDS Relief (PEPFAR) is the largest single donor having allocated approximately 13 billion for AIDS prevention treatment and care in developing countries and contributed 3 billion to the Global Fund to Fight AIDS Tuberculosis and Malaria since the plans inception in 2003. For the next 5 years the president is seeking a 30 billion appropriation for PEPFAR while Congress is proposing to increase the appropriation to 50 billion and add funding for malaria and tuberculosis programs. In contrast the World Health Organization (WHO) smallpox eradication program conducted from 1967 through 1979 cost less than 2 billion (adjusted for inflation). Funding to provide antiretroviral treatment (ART) for HIVinfected individuals in developing countries is saving lives. The Joint United Nations Programme on HIV/AIDS (UNAIDS) and WHO have reported that global deaths due to AIDS peaked in 2005 and then decreased over the next 2 years a decline at least partially attributed to ART. By the end of 2007 about 3 million individuals living in low- and middle-income countries were receiving ART representing approximately 31% of individuals needing treatment in those areas. While acknowledging the undeniable successes of these treatment programs it is also important to examine some of the problems they may have inadvertently created or magnified: i. e. their unintended consequences as well as their potential for long-term sustainability. This Commentary focuses on PEPFAR and sub-Saharan Africa the region most severely affected by HIV/AIDS. (excerpt)