Should AIDS dollars be spent elsewhere?

LONDON — In the more than two decades since AIDS began sweeping the globe, it has often been labeled as the biggest threat to international health.

But with revised numbers downsizing the pandemic — along with a report that AIDS peaked in the late 1990s — some AIDS experts are wondering if it might be wise to shift some of the billions spent on AIDS to basic health problems such as clean water, family planning or diarrhea.

"If we look at the data objectively, we are spending too much on AIDS," said Dr. Malcolm Potts, an AIDS expert at the University of California, Berkeley, who once worked with prostitutes on the front lines of the epidemic in Ghana.

Malnutrition, pneumonia and malaria kill more children in Africa than AIDS.

"We are programmed to react quickly to small children with AIDS in distress," Potts said. "Unfortunately, we don't have that same reaction when looking at statistics that tell us what we should be spending on."

The world spends $8 billion to $10 billion on AIDS every year, more than 100 times what it spends on water projects in developing countries. Yet more than 2 billion people do not have access to adequate sanitation, and about 1 billion lack clean water.

In a recent series in the journal Lancet, experts wrote that more than one-third of child deaths and 11 percent of the total disease burden worldwide are due to mothers and children not getting enough to eat — or not getting enough nutritional food.

"We have a system in public health where the loudest voice gets the most money," said Dr. Richard Horton, editor of Lancet. "AIDS has grossly distorted our limited budget."

But some AIDS experts said cutting back on fighting HIV, which causes AIDS, would be dangerous.

"We cannot let the pendulum swing back to a time when we didn't spend a lot on AIDS," said Dr. Kevin De Cock, director of the AIDS department at the World Health Organization. "We now have millions of people on treatment and we can't just stop that."

Still, he once worked on AIDS projects in Kenya, his office just above a large slum.

"It did feel a bit peculiar to be investing so much money into anti-retrovirals while the people there were dealing with huge problems like water and sanitation," he said.

"No one is beating the drum for basic health problems," said Daniel Halperin, an AIDS expert at Harvard University's School of Public Health.

Aside from southern Africa, most of the continent has relatively low rates of HIV, and much higher rates of easily treatable diseases like diarrhea and respiratory illnesses. Yet much of the money from the West, especially from the United States, goes into AIDS.

Halperin recently wrote a commentary in The New York Times on the imbalance and said he was astounded by the response. Most were positive, he said, with many AIDS experts agreeing it was time to re-examine spending.

Most AIDS officials said the solution is to boost the budget for all of public health, but that may be wishful thinking.

"At the end of the day, there are limits to how big the public-health pie can be," Halperin said.