Feature Head to head

Are we spending too much on HIV?

BMJ 2007; 334 doi: http://dx.doi.org/10.1136/bmj.39113.402361.94 (Published 15 February 2007) Cite this as: BMJ 2007;334:344
  1. Roger England (roger.england@healthsystemsworkshop.org)
  1. Health Systems Workshop, Grenada, West Indies

    Billions of pounds are being spent on the fight against AIDS in developing countries. Roger England believes that much of the money could be better used elsewhere, whereas Paul de Lay and colleagues argue that current spending is not enough

    HIV is receiving relatively too much money, with much of it used inefficiently and sometimes counterproductively. Data from the Organisation for Economic Cooperation and Development show that 21% of health aid was allocated to HIV in 2004, up from 8% in 2000.1 It could now exceed a quarter. Yet HIV constitutes only 5% of the burden of disease in low and middle income countries as measured by disability adjusted life years lost (DALYs),2 less than that for respiratory infections, perinatal conditions, or ischaemic heart disease. It causes 2.8 million deaths a year worldwide—fewer than the number of stillbirths, and much less than half the number of infant deaths.2 More deaths are attributable to diabetes than to HIV.3

    Even within sub-Saharan Africa, HIV funding is out of balance. HIV is the biggest single killer, contributing 17.6% of the …

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