International funding for AIDS care in poor countries should be increased

BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7291.924 (Published 14 April 2001) Cite this as: BMJ 2001;322:924
  1. Amir Attaran, director (amir_attaran{at}harvard.edu)
  1. Macroeconomics and Health, Center for International Development at Harvard University, John F Kennedy Street, MA 02138, USA

    EDITOR—Yamey's investigation of infant formula donations in Africa was excellent.1 Whether to use infant formula is a difficult question because it takes place against the backdrop of two big issues: breast feeding and AIDS. Breastfeeding activists fear that if Nestlé or Wyeth get a foot in the door of donating infant formula to women in poor countries, those firms will resume their wrongful marketing practices of the past and will target women who are HIV negative to cultivate a new market for formula. Very few women know their HIV status, which makes it impossible to direct the donation to those who could benefit from it.

    The welfare of women and their babies is best protected by increasing international funding for AIDS care in poor countries. This would allow the manufacturers' donation to be deployed safely. Some of the aid money should be used to test pregnant women for their HIV status. For women who test negative, breast feeding should be promoted as usual. Women who test positive should be given nevirapine to block the transmission of HIV to the infant during labour (Boehringer-Ingelheim offers it for free). They should be given highly active antiviral treatment (HAART)—offered cheaply by many companies—to prolong their lives, so that the children will not become AIDS orphans. They should be given infant formula and receive education in how to use it safely (thereby taking up Nestlé's and Wyeth's offer). Such a plan maximises public health.

    The dispute here is a tempest in a teapot created by impoverished healthcare budgets that make the above steps unaffordable. Nestlé, Wyeth, Unicef, and breastfeeding activists should approach the governments of the oil exporting countries as donors. These 22 governments could easily provide the $10bn annually that may be needed for this and other AIDS needs (their aggregate national income is $21trillion). Yet their aid for AIDS in Africa recently totalled only about $70m annually, or perhaps twice that at most.2

    Impoverished international aid makes for impoverished health systems and impoverished policy options that nobody agrees on. Changing this status quo, and demanding that wealthy governments fund AIDS care decently, would be far more productive than the conflict engaged in so far.


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