In their influential paper in The Lancet in 2001, Jeffrey Sachs (nominated by Time Magazine as one of the 100 most important people on the planet) and Amir Attaran (a frequent critic of international health and development agencies) laid out the pitiful state of global spending on AIDS control.
Sachs and Attaran estimated that between 1996 and 1998, finance from all rich countries to sub-Saharan Africa for projects designated as AIDS control averaged just $69 million annually. While it is certainly true that this figure has increased since the establishment of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, we are still far short of the $15 billion needed annually by 2007 for AIDS control.
As Sachs often reminds his audiences, while $15 billion sounds like a large sum, this is just 15 days of US military spending. And funding HIV prevention and treatment would have a much more profound effect on global security than funding any kind of military intervention.
If we don't get serious about financing AIDS control, many countries simply won't meet the 2015 Millennium Development Goals. A compelling policy paper in today's PLoS Medicine, by researchers from the International AIDS Vaccine Initiative and EASE International, outlines the ways in which HIV/AIDS is stalling progress toward reaching at least five of these goals: halving extreme poverty and hunger; reducing childhood deaths; achieving universal primary education; improving maternal health; and tackling infectious diseases, such as TB and malaria.
As an example of how HIV/AIDS is contributing to poverty, the researchers found that HIV/AIDS typically lowers national GDP by up to 1.5% annually, with an even greater impact on economic development in Africa.
Reaching the health-related MDGs will undoubtedly require an expanded cadre of health professionals in sub-Saharan Africa. And yet HIV/AIDS is again getting in the way. For example, a retrospective cohort study of the fate and career destinations of doctors who qualified at Uganda's Makerere Medical School in 1984 found that 30% had died over the next 20 years, largely due to HIV infection.
As Dan Ncayiyana, vice chancellor of the Durban Institute of Technology, South Africa, put it an editorial in the BMJ: "A stronger health system is necessary for more effective prevention and care of HIV and AIDS, which the attrition among health professionals will only serve to undermine."
Sub-Saharan Africa cannot reach the MDGs unless nurses and doctors are kept alive.