Financial aid against AIDS is slipping

By Susan Litherland

LONDON: Development agencies are detecting signs of donor fatigue in the fight against AIDS and are worried that industrialized countries are coming to view the syndrome as a Third World problem.

Although figures from the Global AIDS Policy Coalition, a U.S.-based NGO, show the total aid available from international donors for developing nations (excluding World Bank loans) has risen slightly over the years, it does not match the rise in the numbers of those contracting the fatal illness.

In 1991, international donors set aside US$230.35 million for developing countries to go toward researching and controlling AIDS. In 1993, the figure was $236.34 million. Experts say this actually constitutes a clear decline in aid since the number of people contracting HIV, which causes AIDS, has sharply increased in comparison.

Asia in particular is facing an explosion in HIV infections. From the current three million, the World Health Organizations (WHO) predicts the number could leap to 10 million within five years.

The focus on drugs and vaccines made sense ten years ago and a scattering of anti-viral drugs which slow down HIV's progress now exist. But after much effort none has been found to prevent the onset of AIDS and the subsequent death, and scientists are growing "despondent, tired and burnt out", says expert Laurence Zavriew.

"Although more has been learnt in a short time about AIDS than about almost any other disease, there is still to much we don't know," says Zavriew, editor of a new report on AIDS released by the Panos Institute, a London-based development agency.

"We don't understand why some people with HIV can stay healthy for up to 15 years while others rapidly develop AIDS," he says. "We don't know how HIV attacks the immune system, or whether the immune system puts up an effective defense against the virus at any stage before it is destroyed."

Hardest hit by any fall off in funding will be the developing world where about 90 percent of HIV cases occur. More than 11 million of the estimated 18 million adults infected worldwide since the pandemic took hold in the early 1980s are in sub- Saharan Africa. In 1994, however, only 13 percent of the $1.5 billion spent globally each year on efforts to prevent infection went to the South.

According to Jeffrey O'Malley, executive director of the London-based International HIV/AIDS Alliance, the initial panic over the spread of HIV in the North has not matched reality, whereas in Asia the numbers outstripped expectations.

He observes: "This geographical shift of focus has made AIDS less of a priority in the North and boosted the tendency to see it as some marginal tropical disease."

The United States, the largest contributor to HIV/AIDS work in developing countries, spends about $2.1 billion per annum on humanitarian and development assistance, but the Republican-led Congress is considering a 30 percent cut next year.

O'Malley says funding specifically for AIDS is on its way down as donors change their approach from one of reacting to an emergency, to a building of long-term programs. Donors now talk of integrating HIV/AIDS into regular development work, which may mean just adding one more task to overloaded health programs, without providing specialist support.

"People often think AIDS get too much money, but in 1990, before most of the cutbacks, contributions to HIV/AIDS work represented only .32 percent of all official development assistance from rich to poor countries," says O'Malley.

The Alliance, which acts as a central channel for resources to linking organizations in the Third World, wants to see more money going to community works on AIDS. But scientists themselves are making a case for more funds, claiming they are at a turning point in the history of the disease.

"The current inadequacy of treatments for HIV infection and the absence of a vaccine to protect the uninfected are largely due to the wide gaps in our understanding of the underlying disease process," said William Paul, director of the U.S. Office of AIDS Research, at an AIDS conference in Japan last year.

"If we do not provide innovative scientists with the resources and opportunities to attack the basic unsolved problems related to AIDS and HIV", he added, "we may find that a decade from now, we are no further along in our struggle."

Panos says the return to basic research is leading some scientists to examine in detail what happens when the virus infects people. For example, the Aaron Diamond AIDS Research Center in New York has shown that even when people have no symptoms of the disease, the virus in their body is rapidly reproducing itself.

Each new virus particle stimulates the production of defense cells known as CD4T cells. The researchers believe this creates a rapid turnover of defense cells which then become severely depleted, making the person vulnerable to other infections.

Another focus of interest is a group of defense cells known as dendritic cells, which act as agents of introduction in the immune system. They bring into the body foreign proteins such as those from the infectious agents, to meet the other defense cells, stimulating them to respond.

As the first line of defense, these cells may be vital in protecting the body from infection. But some researchers have suggested that HIV destroys the normal function of dendritic cells, leading to a collapse of the rest of the immune system.

At present, treatments for opportunistic infections aside from HIV itself have enabled people in the North to live for about two years after AIDS has been diagnosed. But in the South, where even basic antibiotics can be in short supply and too expensive for sufferers, the survival rate is much shorter.

-- IPS