Ahead of the final day of the International AIDS Conference-AIDS 2010 on Friday, a New York Times analysis piece reports that growing concerns over funding for HIV/AIDS have dominated the focus of the conference. According to the newspaper, this has affected “organizers’ efforts to get publicity for the Vienna Declaration, which calls for drug users to be spared arrest and offered clean needles, methadone and treatment if they have AIDS.”

With signs the global economic downturn has led donors to scale back HIV/AIDS commitments, “[f]rustration [at AIDS 2010] is high” with some advocates criticizing President Barack Obama and what they see as “shifting” U.S. priorities, the newspaper writes.

Meanwhile, the article notes a joint report released Sunday by the Kaiser Family Foundation and UNAIDS that showed “the United States still gives more for AIDS assistance than all other countries put together, accounting for 58 percent of contributions,” and the country’s “donations are still going up slightly, while those from Europe, Canada, Japan and Australia are flat or falling.”

The article addresses the significance of the Vienna Declaration, which marks “only the second time the International AIDS Society has issued such a document,” and offers a description of the theory behind its creation. “The declaration contends that arresting drug users forces them into hiding, spreading the epidemic. It backs ‘science-based public health approaches’ proved in clinical trials, which can include everything clean needle swaps, 12-step recovery programs and methadone,” the newspaper writes.

“Only two governments reacted to the declaration: Canada, which rejected it, and Georgia, whose first lady signed it in a public ceremony,” the article continues (McNeil, 7/22).

Global Fund; Calls For Efficiency; Sustaining Treatment; Scaling-Up Prevention

The Associated Press reports on how concerns that when the Global Fund to Fight AIDS, Tuberculosis and Malaria meets in October to decide on its “financing levels for the next three years,” it will fall short of its goal to receive “a desired $20 billion in pledges.”

The article includes comments by Nicci Stein, director of the Canadian-based Interagency Coalition on AIDS and Development, and Michel Kazatchkine, executive director of the Global Fund, who on Thursday at AIDS 2010 spoke about their fears that scaled back commitments to the program could lead to a reversal in gains made in recent years.

HIV/AIDS advocates warn “that underfunding would be particularly problematic for sub-Saharan Africa,” the news service notes. “Programs financed by the Global Fund were providing antiretroviral treatment to 2.5 million people at the end of 2009” (Oleksyn, 7/22).

“[J]ust $10bn was agreed in the previous round [of Global Fund financing commitments]  – some of which still has to be paid over by donors,” the Financial Times writes in an article that explores how growing tensions over funding for HIV/AIDS “are triggering demands for greater efficiencies” in global HIV/AIDS programs – a topic highlighted by former U.S. President Bill Clinton Monday during an AIDS 2010 address.

“But greater efficiency has its limits. The absolute sums spent have grown much larger in recent years – partly because the more HIV patients are given drugs, the longer they survive,” the newspaper writes. “This growing ‘treatment mortgage’ means ever more new money is required to sustain existing programmes, before even adding a single new patient. The tension has been compounded by recently released changes to international treatment guidelines, which say patients should be started on therapy at an earlier stage after infection, when their immune systems are still stronger,” the Financial Times continues.

Although HIV/AIDS experts “hope that the long-term effect will be to ease the burden on doctors and hospitals by reducing or deferring the more serious stages of the disease[,] … the short-term consequence is yet more patients requiring antiretroviral drugs, at an estimated additional cost of $2bn a year,” the Financial Times writes.

The article details additional concerns over starting HIV treatments earlier, including an increase in the number of patients “who will develop resistance to ‘first line’ drugs and require alternative fallback therapies, most of which remain on patent and at higher prices,” and highlights efforts being made within PEPFAR to increase the program efficiency.

According to the newspaper, Ambassador Eric Goosby, the U.S. global AIDS coordinator, “is focused on achieving what he estimates could be savings of 20-30 percent through administrative changes, shifting work away from U.S.-based consultants to people living in recipient countries. He also calls for more focused prevention efforts, without which treatment will struggle to catch up with the number of new infections” (Jack, 7/22).

“No one likes to have their cash cut off but it does concentrate the mind wonderfully on doing more with less – especially with regards to the additional costs that come with treating patients,” the Economist writes in an article that explores some of the major topics presented at AIDS 2010. “As is well known, drug costs have already declined dramatically. Treatment that in 1995 cost $10,000 a year is now less than $100. But the other annual costs of delivery – staff, infrastructure and so on – are about three times this amount,” according to the article.

“The consensus at the conference seemed to be to take things out of the hands of expensive doctors and give them to nurses or, better still, paramedics. In part that means more training; it also means simpler treatment regimes (fewer pills per day); and it means changing expectations about who will do what. Christoph Benn of the Global Fund, an international body formed to fight AIDS, tuberculosis and malaria, reckons that this could bring the additional, non-drug costs down to $100 per course of treatment per year. That would please donors,” the magazine writes (7/22).

IRIN/PlusNews features “a list of ways HIV service providers could cut costs and improve efficiency,” including the creation of simpler drug delivery systems, greater use of technology and health system integration (7/22).

Tension Between Scientists, Policy Makers

Reuters examines tension between scientists and policy makers. “Despite promises from governments around the world to pursue evidence-based policies, AIDS experts are frustrated at a refusal to adapt to new ways of looking at HIV and the people most at risk of contracting it,” the news service writes. “It is a stance that displays discrimination and criminal negligence, says [AIDS 2010 co-chair] Julio Montaner, president of the International AIDS Society, who has led a drive at the conference to get politicians to wake up to the evidence.”

The article details some of the scientific advances presented at AIDS 2010, including recent data on HIV prevention strategies, such as an ARV-containing microbicide and male circumcision, and highlights UNAIDS new strategy to “improve the efficiency in the global AIDS effort by developing more simplified drugs and delivery systems and using more community health workers.”

“The message from scientists is: we’ve given you the tools and the evidence, now give us the money to use them,” the article continues.

Nathan Ford, a Medecins Sans Frontieres (MSF) doctor, who works on AIDS programs in Africa, said of the funding gap, “The big frustration is that we feel we have really responded to the call of proving certain efficiency models. … I get the sense that no amount of data is going to change things. The decision has already been taken – but that is not how global health should be run.”

The article also includes comments by UNAIDS Director Michel Sidibe, Nobel Laureate Francoise Barre-Sinoussi and the Global Fund’s Kazatchkine (Kelland, 7/23).

Recent Scientific Advances Have Researchers, Doctors Rethinking How Best To Treat HIV

The Wall Street Journal reports on how recent scientific advances have led scientists and doctors to rethink how best to treat HIV. Although “[t]he medical community had been wary of starting people on drugs too soon because of concerns about side effects and drug resistance” and the cost of starting treatments early in the developing world, the latest science “supports an emerging argument for starting AIDS treatment as soon as possible after infection, to thwart the virus’s devastating effect on the body’s immune system,” the newspaper writes.

“The earlier you treat, the more preserved is the immune function,” said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID).

“Yet early treatment could cost billions of dollars, at a time when funding to combat AIDS globally has tightened. Only about 5.2 million people in low- and middle-income countries are receiving treatment, with some 10 million to 15 million more eligible for the medicines if financial support were available to pay for them. Worldwide, an estimated 33.4 million people are infected with HIV,” according to the article.

“The scientific consensus continues to move toward earlier and earlier treatment,” said Kevin Frost, chief executive of amfAR – the Foundation for AIDS Research. “The political concern is how to pay for it.”

The article details scientists’ current understanding of how the HIV virus moves from point of contact when a person first becomes infected with HIV, through early replication, noting the crucial window of time that scientists believe the virus appears most vulnerable (Winslow, 7/22).

IRIN/PlusNews also provides an overview of current research efforts to stop the HIV virus.

“The main focus of current research is how to find and tackle ‘reservoirs’ – cells, organs or tissue in the body where the virus could remain latent – and eventually become active again,” the news service writes. “Current research is seeking a ‘functional cure’, which would not eliminate the virus from the body but would allow a patient’s immune system to control the virus without the need for lifelong medicine by using antiretroviral (ARV) drugs and medications for a limited period to target these reservoirs. At least two clinical trials are underway in France to test such products.”

The article includes comments by several scientists and notes the challenges of developing a cure for HIV/AIDS (7/23).

All of the Kaiser Family Foundation’s webcasts of select sessions from AIDS 2010 are available at www.kff.org/aids2010.