Philanthropists Question Harvard Report’s Emphasis on AIDS Treatment, Say Focus Should be on Prevention
The heads of the United Nations Foundation, the Rockefeller Foundation and the Bill and Melinda Gates Foundation on Friday expressed concern that a new Harvard report urging that billions of dollars be spent to treat people with HIV/AIDS in Africa could undermine the need for a greater focus on prevention efforts, the Boston Globe reports. The Harvard report, released last Wednesday, calls for $1 billion in initial funding to provide HIV-positive Africans with antiretroviral medications (Donnelly, Boston Globe, 4/7). The report also recommends that an additional $3 billion a year go toward prevention and treatment programs other than antiretroviral therapy ( Kaiser Daily HIV/AIDS Report, 4/5).
The Globe reports that the Harvard proposal "turned heads" among global health advocates worried about the "logistical problems of building sustainable health systems in sub-Saharan Africa." Bill Foege, a senior adviser to the Gates Foundation, said that the Harvard report "underestimates how difficult it is to do the infrastructure. ... My concern is [that] drugs could get ahead of the infrastructure, and then [there is] the possibility of [drug] resistances developing. As bad as AIDS in Africa is, one thing is worse: AIDS in Africa with antiretrovirals used incorrectly and resistances developing" (Boston Globe, 4/7). Timothy Wirth, president of the United Nations Foundation, added, "In any political system, the pressures for funding come from people who are already sick. ... I'm concerned that all of the pressure on treatment issues will squeeze out prevention." Bill Gates said that it was "fantastic to see the AIDS crisis getting the increased visibility it deserves" (Garrett, Newsday/WashingtonPost, 4/8). However, he warned that prevention needs to be a "priority" because if "things aren't different, an additional 75 million people will be getting the disease in the next 20 years." Jeffrey Sachs, the Harvard economist who wrote the proposal, responded that he did not disagree with the opinion that "prevention needs to be in the forefront of efforts to fight AIDS." He added, however, that the report was not a "comprehensive plan for AIDS control. It was about the feasibility of antiretroviral therapy in developing countries" (Boston Globe, 4/7).