Defining and refining international donor support for combating the AIDS pandemic

The international aid effort against AIDS is greatly incommensurate with th e severity of the epidemic. Drawing on the data that international aid dono rs self-reported to the Organization for Economic Cooperation and Developme nt (OECD), we find that, between 1996 and 1998, finance from all rich count ries to sub-Saharan Africa for projects designated as AIDS control averaged US$69 million annually, and, assuming a safe margin for under-reporting an d misreporting, we estimate that total donor spending on HIV/AIDS control w as perhaps twice that at most. Since the late 1980s, aid levels have droppe d relative to the prevalence of HIV infection, and stood recently at about $3 per HIV-infected person. Lack of finance is now the primary constraint o n progress against AIDS, notwithstanding the widespread belief that a lack of interest from the governments of poor countries is limiting. We argue th at to produce a meaningful response to the pandemic, international assistan ce must be based on grants, not loans, for the poorest countries; be increa sed within the next 3 years to a minimum of $7.5 billion or more; be direct ed toward funding projects which are proposed and desired by the affected c ountries themselves, and which are judged as having epidemiological merit a gainst the pandemic by a panel of independent scientific experts; and fund concurrent needs, including prevention, drug treatment (such as highly acti ve antiretroviral therapy), and blocking mother-to-child HIV transmission. An effort of this scope and scale will both radically alter the prospects f or intervention against AIDS in poor countries, and together with comparabl e efforts to control other infectious diseases, is easily afforded by the O ECD donor economies, whose aggregate national income recently surpassed $21 trillion annually.