BMJ  2007;334:439 (3 March), doi:10.1136/bmj.39136.450359.FA

Letters

Spending on HIV

HIV funding: debate misses the point

As one who has lost five out of 11 siblings to HIV, I cannot but be aware of the magnitude of HIV. Though the figures of England and de Lay et al differ,¹² the element of relative overspending on HIV compared with other health and social developmental sectors is obvious.

Both miss the crucial point that HIV is the only tropical disease receiving anywhere near Western rates of health funding. The reasons for this include the global nature of HIV, the wages and expenses of expatriate health workers, and the many groups working with HIV in the tropics. England could have argued that the money channelled into HIV should be spent through local national health departments. Some African non-governmental organisations and de Lay et al may argue for the status quo, which has created, in some cases to the detriment of health and governance institutions, parallel institutions as it benefits their causes. England should have presented a breakdown of how the HIV funding is being used. He may find that only a small fraction trickles down to African patients with HIV and that a significant chunk bounces back to the West.³

Rutherglen, Glasgow G73 3SN

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Competing interests: None declared.

References

1. England R. Are we spending too much on HIV? BMJ 2007;334:344. (17 February.)[Free Full Text]
2. De Lay P, Greener R, Izazola JA. Are we spending too much on HIV? BMJ 2007;334:345. (17 February.)[Free Full Text]
3. Lwanda J. Politics, culture and medicine in Malawi: historical continuities and ruptures with special reference to HIV/AIDS. Zomba: Kachere, 2005.

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