Less might be more in funding HIV programmes

In an eminently sensible editorial, Daniel Halperin recently argued that the vast resources available for AIDS in the developing world, and especially in Africa, are threatening to crush other important priorities such as basic sanitation. This has prompted a prickly response from the Global AIDS Alliance. Somewhat predictably, the Global AIDS Alliance argues that we do indeed need more money for sanitation, child survival and basic poverty reduction programmes. But they suggest that this should go hand in hand with MORE money for AIDS programmes. In other words, funding for development should not be a zero sum game, where more for one disease or development priority means less for another.

Fair enough, in principle. But our world is not governed by principles, it is governed by politics, institutional self-interest and money. The Global AIDS Alliance has shown an admirable understanding of all three of these things in the past. By saying “We need more of everything (except defence spending)”, the Alliance response does not address Halperin’s central point: funding “development” according to fashions, whims and corporate interests of donor nations creates distortions which suck attention, effort and the most precious of all resources — intelligent, trained and committed human beings — away from the areas where they are needed and towards the areas where they get paid most. What we’re not allowed to say is that in most countries, that means that people with HIV — people who have chosen to shoot up drugs with other people’s needles, people who have chosen to have unprotected sex with people they know might have a fatal sexually transmitted disease — get first class services, where as people who just want to drink clean water or get treatment for respiratory infections brought on by the clouds of pollution in which they live get no services at all.

This post was published on 08/01/08 in Money and AIDS, Pisani's picks.

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  1. Comment by Claire D Aire, 08/01/08, 05:06:


    Are respiratory infections ‘brought on’ by pollution or caused by micro-organisms? As an epidemiologist I thought you might know.

    Claire D Aire

  2. Comment by elizabeth, 08/01/08, 05:33:

    Fair cop! That was extraordinarily lazy language. Aggravated, then. (And that I know not because of my profession but because I drive a motorbike in Jakarta, one of the world’s blacker cities.)

  3. Pingback by Global Health Delivery Initiative » Perspectives?, 25/01/08, 05:19:

    […] piece has spurred many comments and reactions by NYT readers. In her Jan. 8 blog post, Less might be more in funding HIV programmes, Epidemiologist Elizabeth Pisani notes that Halperin’s “eminently sensible” op-ed has […]

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