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AMSTERDAM -- International funding for the AIDS epidemic has stalled, with an increasing global funding gap threatening to halt years of progress made against the epidemic, members of an expert panel said here.
The from UNAIDS issued last week detailed a $6 billion funding gap between what is required to reach the , which require a scaling up in both spending and efficiency.
"To put it into perspective, $6 billion is the entire amount that the U.S. provides each year, so to fill that gap, the U.S. would have to double what it's doing and that's not going to happen," Jennifer Kates, PhD, of the Kaiser Family Foundation said at a press conference at the
Despite a "dramatic scale-up" in funding when PEPFAR and the Global Fund were launched, she pointed out that funding has been flat for several years and is expected to return to lower levels next year. Kates added that the majority of donor governments decreased spending in 2017, and that funding has not returned to its peak levels from donor governments in 2014.
Deepak Mattur, MBA, of UNAIDS, added that the funding is almost 20% short to achieve the 2020 targets. He warned that not fully funding the AIDS response could have a "drastic impact" worldwide.
"If targets are missed for 5 years, there will be 2.1 million new infections and one million more deaths," Mattur said. "Filling the gap is urgent and time is running out."
Mitchell Warren, executive director, AIDS Vaccine Advocacy Coalition, told 鶹ý that this funding crisis is not new, and people have been late in recognizing it.
"We were off-track before we even set [2020 Fast Track] targets. We should've been making these course corrections before, and I'm surprised it's taken them so long to understand that we're off-track," he said.
When asked about the U.S. involvement specifically, Kates told 鶹ý that Congress rejected "pretty significant" proposed Trump administration budget cuts to PEPFAR and the Global Fund for the past 2 years, and that both programs have been funded at the same level and are expected to be again next year.
The proposed reductions were "a big change from the prior administration, as there have never been proposals to cut this program," she said. "These programs are really a statement about priorities."
She added that the Kaiser Family Foundation analyzed what cuts of those magnitude would have meant, including a dramatic impact on the number of new infections, AIDS deaths, and people treated with antiretroviral therapy.
"It's not just dollars we're talking about, it's people's lives," Kates said.
John Stover of Avenir Health, a global health research firm in Connecticut, discussed at the press conference how the money that is allocated to the fight against the epidemic can be best used -- that is, how much does it cost to provide a service, such as voluntary medical male circumcision or reaching a sex worker with health information or even distributing a condom.
He also noted substantial variation by country for providing the same service, ranging from a couple of hundred dollars to seven to eight thousand dollars to treat one person.
"We've achieved progress with level funds by improving the efficiency by which the programs are delivered," he said. "Lots of programs are effective, but we're missing opportunities to deliver the service more effectively."
They examined 13 interventions in 52 countries to determine whether the funds were going to the right places and used for the most cost effective interventions. While all interventions were cost effective somewhere, Stover said the ones that were cost effective in the most locations were condoms, outreach to sex workers, voluntary medical male circumcision, and opioid substitution.
Stover stressed the importance of organizing a long-term sustainable response and generate enough funding without forgetting "the short-term push we need to make right now" to achieve 2020 targets.
Kates offered an analogy to fighting a wildfire when comparing short-term response to long-term funding goals.
"We're at that tension point, where people are looking around and saying in the longer term, we have to pay attention to those other areas, but it's still paying attention to that wildfire," she said.