Cutting U.S. foreign aid for HIV would cost lives, without much savings

(Reuters Health) - Reducing U.S. foreign aid for HIV prevention and treatment might not save that much money in the long run, and it could lead to a surge in new infections and fatalities, a new study suggests.

A U.S. budget proposal to reduce foreign aid by one-third would affect more than $6.7 billion currently earmarked for HIV/AIDs research, prevention and treatment, researchers note in the Annals of Internal Medicine, online August 28.

In South Africa alone, cutbacks could result in more than 500,000 additional cases of HIV and more than 1.6 million more deaths within the next decade, researchers estimate.

At most, the proposed budget cuts would save just $600 to $900 for every year of life lost in South Africa and the Ivory Coast, researchers estimated, because any initial savings would lead to high costs down the line to treat more people infected with HIV.

“This is not an epidemic we can kick down the road and think it will go away,” said lead study author Dr. Rochelle Walensky, an infectious disease researcher at Harvard Medical School and Massachusetts General Hospital in Boston.

“Loss of investment now will mean bigger problems and price tags later,” Walensky said by email.

To assess the potential impact of foreign-aid cuts on the global effort to combat HIV, researchers compared current standards for starting antiretroviral therapy and keeping people on the drugs to what might occur with fewer resources.

Researchers looked at cost data from the Republic of South Africa and the Ivory Coast to see what might happen in each country if HIV screening was reduced, access to medication was limited to the sickest patients, access to alternative drugs when initial treatments don’t work was eliminated, and lab tests to monitor patients and efforts to keep people in long-term treatment were cut back.

They estimated how much money could be saved by each of these moves, how many new infections and deaths would occur, and how many additional years of life would be lost.

Existing commitments to patients already receiving care for HIV infection would restrict overall saving to no more than 30%, the researchers estimated. As currently proposed, the U.S. foreign-aid budget cuts would not reduce care for people already on treatment.

Over time, those savings would dry up, as the increase in HIV transmissions would lead to accumulating costs for the care of those patients, the researchers conclude.

One limitation of the study is that researchers don’t know what changes would actually be made to HIV prevention or treatment based on the proposed U.S. foreign-aid cuts.

Even so, the analysis offers a preview of what could happen after cutting back investment in HIV prevention and treatment, said Arleen Leibowitz, a public policy researcher at the University of California, Los Angeles, who wasn’t involved in the study.

“Early antiretroviral treatment has a double benefit - it improves health and survival of the HIV-infected person, but also cuts down on transmission,” Leibowitz said by email. “This, in turn, will reduce long-run costs.”

When newly infected patients start antitretrovirals quickly, they can become non-contagious within two to three months, noted Dr. Eric Goosby of the University of California, San Francisco School of Medicine.

“The drop in the number of infections creates less utilization of clinics, emergency services and inpatient service, thereby saving money,” Goosby, who wasn’t involved in the study, said by email.

Cutting back in HIV investments now would reverse extraordinary gains made in saving lives and reducing new HIV infections, said Dr. Diane Havlir, chair of the UNAIDS Science and Technology Advisory Committee.

“Such pullbacks would ensure we would pass on HIV epidemic for generations to come,” Havlir, who wasn’t involved in the study, said by email.


Ann Intern Med 2017.