By Marilyn Chase
April 6 (Bloomberg) -- The largest U.S. foreign aid program fighting the AIDS epidemic has cut the disease’s death toll by 1.2 million from 2004 to 2007 in a dozen hard-hit African countries, researchers said.
The President’s Emergency Plan for AIDS Relief, started by President George W. Bush in 2003, lowered the AIDS death rate on average by 10.5 percent a year in those countries, said study author Eran Bendavid of Stanford University in a study published online today in the Annals of Internal Medicine. The program’s benefits didn’t extend to preventing new infections or lowering overall prevalence of the AIDS virus.
The largest single U.S. foreign aid program for health in history, the PEPFAR program has invested most of its $18.8 billion to date in treatment for people already infected by the AIDS virus. The relief plan devoted a smaller share to prevention programs that often focused on sexual abstinence.
“Treatment has worked,” said Bendavid, a fellow in infectious diseases and health policy, in an interview. The challenge now is to make prevention “a serious component of the program in the next five years,” he added.
The epidemic has left 33 million people sickened by AIDS or infected with the virus, HIV or human immunodeficiency virus. Congress reauthorized the AIDS relief program in July 2008, boosting funding to $48 billion through 2013, broadening its disease targets to include tuberculosis and malaria and removing the focus on sexual abstinence. Plans are under way to expand recipients from the original list of 15 countries.
Money Tight
In an era when money is tight and the cost-effectiveness of foreign aid is coming under closer scrutiny, Bendavid said, “People want to see where it’s spent and where it’s working best. We did this to see if we could contribute to the debate about the usefulness of foreign aid.”
The study found that the program’s cost per life saved was $2,450 during 2004 to 2007.
“PEPFAR is changing the course of the AIDS epidemic,” said Peter Piot, former executive director of the United Nations Joint Program on HIV/AIDS (UNAIDS) in a statement released today.
“People are not dying. That is spectacular,” Piot said in a telephone interview today. “The irony -- and it is a positive irony -- is that the more people are staying alive, the higher the percentage” of those living with HIV will be.
Complacency
Piot added, “Is this going to have a beneficial impact on the spread of HIV, or will it lead to complacency and relaxation?”
Bendavid and his co-author Jayanta Bhattacharya, associate professor of medicine at Stanford, used statistics collected by UNAIDS to compare the AIDS death rate in 12 PEPFAR countries in Sub-Saharan Africa to that of 29 countries in Africa that didn’t receive PEPFAR funds.
The PEPFAR countries in the study included Botswana, Cote d’Ivoire, Ethiopia, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda and Zambia. Three original recipient countries outside Africa -- Guyana, Haiti and Vietnam -- weren’t included in the analysis.
In South Africa from 2004 to 2007, about 1.3 million people died of AIDS -- or 130,000 fewer deaths than would have been expected before the PEPFAR program, Bendavid said.
“We wanted to see if this program can have a palpable effect,” he said. “The answer is: without a doubt. They spend a lot on treatment and treatment has worked. Foreign aid can have an unequivocally positive effect in Africa.”
Infection Rate Steady
PEPFAR didn’t affect the percentage of people aged 15 to 50 infected with the virus. In South Africa, for example, the prevalence of HIV infection still hovers between 18 percent and 19 percent, he said.
Because treatment kept people alive, the number of people living with the virus remained relatively higher in some PEPFAR countries than in countries that didn’t get the funds, Bendavid said.
“This increase probably reflects the decreasing death rate and may have several public health spillover benefits,” Bendavid wrote. “For example, infected adults who live longer may be able to support their children and dependent elderly family members, reducing the burden of orphans and elderly care.”
“Bringing down prevalence is important and difficult,” he explained in an interview. “You need to reduce the number of new people infected by at least as many as the number of people you’re keeping alive.”
The study was funded by the U.S. Agency for Healthcare Research and Quality.
To contact the reporter on this story: Marilyn Chase in San Francisco at mchase6@bloomberg.net
Last Updated: April 6, 2009 17:06 EDT
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