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AIDS Funding Boosts Overall Healthcare

Donald S. Shepard, Ph.D., is Professor at the Schneider Institutes for Health Policy at the Heller School, Brandeis University.
Donald S. Shepard, Ph.D., is Professor at the Schneider Institutes for Health Policy at the Heller School, Brandeis University.
Joe DeCapua

The battle against HIV/AIDS has received more donor funding than most other diseases combined. Many tens of billions of dollars has been spent in the more than 30 years of the epidemic. The amount of funding has raised concerns among some that attention is being taken away from other killer diseases. Now, a new study says that’s not the case.

The 6 year study took place at health clinics in Rwanda.

Dr. Donald Shepard of Brandeis University, lead author, said, “There’d been a lot of speculation on both sides: The negative side that it drew attention, resources away -- and conversely on a positive side that it could help the health system more generally. And so we thought that an empirical study could help throw light on this.”

He said Rwanda offered an opportunity to settle the debate.

“The AIDS program was in the process of being rolled out to many health facilities. So that it made it possible to do this controlled study of looking at facilities that already had AIDS services and other facilities that were similar but didn’t. To try to see in that country at least what the actual impact had been,” he said.

Reaching a conclusion

Researchers focused on how those clinics performed.

“There were two teams of researchers that visited each of the health centers in the study. We developed a questionnaire that compiled data about – what in lingo is termed – inputs and outputs into each of the health centers. The inputs were the staff that they had drugs and other items that they received and the outputs were a series of services that they produced, particularly in terms of visits and vaccinations and other types of services by health facility by year,” he said.

The findings were published in the May edition of the American Journal of Tropical Medicine and Hygiene. They refuted claims that efforts against other diseases were being harmed by the large amount of funding for HIV/AIDS.

“We concluded,” said Shepard, “that there was no evidence at all of the adverse effect that some researchers had feared and speculated about – and some evidence that indeed that there were positive spinoffs.”

The study said one of the positive spinoffs was that health centers offering AIDS services “provided better preventive care than those that did not, including superior delivery of childhood vaccinations.”

Integration

Shepard added that “Rwanda’s progress against HIV/AIDS has not come at the expense of addressing other health needs.”

“Rwanda has had a very deliberate policy of integrating AIDS services into its healthcare system. So while from a donors’ viewpoint AIDS has separate mechanisms – in Rwanda’s case the Global Fund and PEPFAR – within the country itself it had made a very conscious effort of trying to integrate AIDS into the healthcare system and has helped to strengthen the healthcare system more generally in Rwanda,” he said.

The Global Fund to Fight AIDS, Tuberculosis and Malaria and the President’s Emergency Plan for AIDS Relief provide much of the funding for treatment, care, prevention and research.

Researchers said further evidence that AIDS funding can boost overall healthcare in a country can be found in an Ethiopian study. Following an increase in AIDS spending, Ethiopia saw a decline nationwide in mortality rates while immunization rates rose and “pre-natal care improved.”

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