Should ‘Poor Countries’ Be Doing More to Finance Their HIV Fights?
Science magazine reporter Jon Cohen speaks with the Kaiser Family Foundation’s Jackie Judd about a call Tuesday for a new approach to financing the global battle against the HIV/AIDS epidemic. Read the full transcript below the video.
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Jackie Judd, Kaiser Family Foundation: Jon Cohen of Science magazine, welcome.
Cohen: Thanks, Jackie. It’s another interesting day at the AIDS Conference.
Judd: And if you step back from the speeches, the sessions, the panels, and look at it in a larger way, one of the themes evolving is we’re talking about the evolution of the epidemic in many different ways. And today there was a discussion about the evolution of the financing of the epidemic. Fill us in.
Cohen: Well, we’ve had a period of time over the last decade where there’s been a lot of dependency from poor countries and middle-income countries on wealthy countries. And what we saw in 2011, and this is a talk from Bernhard SchwartlÃ¤nder of UNAIDS, in 2011 there were 81 countries that were taken care of for 50 percent or more of their HIV/AIDS needs. South Africa is at the front of that pack, really went from very little domestic money to taking care of the bulk of it. And the donor countries are saying to the partners, ‘Hey, we expect you to do more…’
Judd: And their contributions have flat-lined in the past several years, correct?
Cohen: As the Kaiser report shows that just came out, yeah, we’ve hit the plateau there, we’ve got a roof problem. So the thing that really startled me about what SchwartlÃ¤nder was saying is there are many, many countries that are going to be moving out of low-income status into middle-income status and that’s going to put pressure on them from the donors to do more and more.
Judd: He said, ‘The world is getting richer. We need to make it fairer.’
Cohen: That’s right. And by fairer, he meant that every country should pay more of their fair share. And many, many poor countries signed on to a declaration that they would pay 15 percent of their health care needs and many have not done it. And he pointed a finger at them and said, ‘Hey, it’s time that you take care of your problem. We’ll help you, but do more.’
Judd: And they will push back, I presume.
Cohen: I think so. I think that the countries that aren’t contributing now aren’t contributing because they feel overwhelmed by other things. But he’s saying, ‘Uh-uh, you’ve got to take care of this, too.
Judd: Another piece of the evolution of this epidemic is the way it looks — who is HIV-positive. You heard about a study today that points to the aging of those who are impacted.
Cohen: Yeah, I was a little frightened because I’m in that aging group. But it’s the over-50 group. But the startling thing to me was that by 2015, half the HIV-infected people in North American and Europe are going to be over 50. I didn’t know that.
Judd: What are the policy implications. Older people, of course, have more complicated health issues.
Cohen: It’s baffling. They have more complicated health issues. They’ve got diseases of aging that are going to compete with their disease. HIV is going to, as one researcher said today, accentuate the likelihood that they get these diseases of aging. And think about it, you’re 65, 70, you’re HIV-infected. You’re taking pills for all these things. HIV is just one thing you’re taking pills for. There could be problems of adherence that we haven’t even imagined. There could be problems with sexuality in that generation. People like to think that people over 50 don’t have sex, but they made the point again and again today that they do and that men over 50 are six times less likely to use condoms. Now imagine there are a lot of HIV-infected men over 50. You can see a potential problem.
Judd: And a final question. One piece of research caught your eye that had to do with a study out of Uganda.
Cohen: Yeah, it was sobering. I’m not sure what it means. It had over 500 couples where one person’s infected at the beginning and another isn’t. Now that’s the very design of a study — a larger study, a better-designed study, that led to the breakthrough notion that treatment is prevention. Because the study published last year showed that it reduced treating the infected partner, reduced the likelihood of transmission by 96 percent. The study today found nothing. Now there could be a whole lot of reasons why. It could be that the person who got infected wasn’t even infected by their partner. The study published last year did genetic analysis to make sure the people who did get infected got infected by their partner. Could be that they were polygamists and that explains it. It could be a bunch of different things. Or it could be that applying this in the real world could be very, very tricky. And there are lots of variables we don’t know yet.
Judd: Well on that we will end it and say thank you.
Cohen: Thank you, Jackie.
Watch this week’s speeches from the International AIDS Conference in their entirety here or on the NewsHour’s Health Page. Also there, find background materials including a primer on this week’s conference in Washington and a look at how the HIV/AIDS fight in the District of Columbia itself compares with a nation in sub-Saharan Africa on three fronts: assisting orphans, preventing the spread of HIV in correctional facilities and reducing stigma in churches.