6. Conclusion

The health of our global workforce is severely threatened by the spread of HIV, and the UN is urging nations to fill the ‘funding gap’ that exists in addressing HIV/AIDS. In 2005, $8.3 billion was available, with an additional $3.3 billion needed; this number grew to $8.9 billion available in 2006 with $6 billion additionally needed. However the emphasis solely on massive financing in misleading. My study joins the body of research and voices of grassroots workers on the HIV/AIDS issue that argue massive funding alone will not achieve global goals to end AIDS.
“Good” policies are important, but better data is urgently needed. Referring back to Table 1, it is troublesome that in 22 cases of aid giving, or over 12% of AIDS-aid recipients, UNAIDS possessed no information about the HIV rate in the recipient nation. There is a troublesome lack of accurate, sufficient data on development, and a lack of transparency and logic in presentation of the numbers that do ‘exist’. Unfortunately funding decisions continue to be made in the midst of insufficient information. There were many variables that I felt would have given a clearer picture as to when aid works and who receives aid, but because of problems like self-reported behavior and politicization of the pandemic, this information does not exist. Better surveillance methodologies for calculating true HIV rates must be created and implemented.
It would be helpful to gather data on broadly exactly what kinds of programs are funded. As noted by Human Rights Watch, “Groups know the more they talk about abstinence, the more they’ll get US funding. And they fear that if they talk about condoms they’ll lose funding – or, worse, get kicked out of the country.” From my experience in Ghana and Tanzania, I met many local leaders of NGOs who wasted much of their time that could have been used to provide services on burdensome grant writing and reporting tasks. In one instance, a leader had to find ways to hide in the budget her distribution of condoms to youth at risk and in need, because her PEPFAR grant did not permit promotion of condom use to young people.
My study is broad and preliminary, and I look forward to specifying further research on populations and regions receiving aid. To really understand effective financing methods, better data on programs and populations are necessary. For example, if pregnant women have significant HIV declines, it would imply prevention efforts are working. If newborns have significant HIV declines, it would imply treatment efforts are working. This population specific data does not exist in a standardized data set and UNAIDS individual country surveillance reports are often missing and abundance of intended measurements.
My study also grossly overlooks the intricacies of funding AIDS initiatives to what programs should money go to best serve the population? While Easterly (2006) argues that treatment efforts are ultimately a less cost effective and perhaps wasteful use of funds, one must also consider the social limitations and complications of effective prevention messaging and consequent behavior change. I cite my own experiences with youth in Ghana and Tanzania, where youth explained the blatant correlation in their vision between increased use of condoms (a product introduced to the continent only after AIDS began to ravage) and increased HIV rates. While at the root of this misunderstanding is an ignorance of the science of contraceptives, which can be ameliorated with an education program, there is a justifiably strong element of trust involved in something as personal as sexual health. Prevention education is complicated and may require more attention and funds - certainly more than the $14 a year for a box of condoms (Easterly, 2006) – than we presently anticipate. Also AIDS treatment is not only saving the life of one person, but consequently, the lives of those dependent on the person. In this specific disease that overwhelmingly kills parents and members of the labor force, treating and sustaining the lives of those most affected mean less AIDS orphans, the next major challenge on the AIDS frontier, and a stronger labor force and revived national economy.
This study therefore suggests that giving money for HIV/AIDS as a disease-specific initiative may be an effective way to decrease the burden of the pandemic. As briefly mentioned in the paper, and implied in the choice of independent variables, AIDS is a syndrome closely entwined with other diseases and health conditions, most of which can be effectively addressed for far less money than AIDS, for example, diarrhea, measles, or malaria. However this study does not abandon the need for AIDS specific intervention, because unlike the most cheaply treated diseases, which also need funds, AIDS comes with uniquely complicated social stigma that creates enormous barriers to access, even when resources and services do exist. For example, someone may choose not to get tested if they suspect they are positive, and therefore not seek treatment, because walking into an AIDS clinic implies to the community that they have been promiscuous or sinful in some way. There is therefore a need to pay closer attention and perhaps spend more money on testing different interventions and initiatives that will break down social stigma – a very real process far more complicated than handing out pills or giving vaccines.
Although data on pledged AIDS-Aid was extractable, the process involved extensive manual gathering of dispersed information. Limited information is publicly available on how the money is actually spent, so this study was restricted to the assumption that money given was money spent, which may not always be the case.
As noted above, It is difficult to measure the opposing influences on HIV prevalence of prevention efforts that reduce new infections and treatment scale-up that reduces deaths among people with HIV. HIV data itself is also suspect, as in 2007 all estimates were revised by the UN based on updated and implemented surveillance methodologies. Data are often missing, as oftentimes countries like Angola, Liberia, or Sudan, have limited HIV prevalence data because of country conflict, yet they are sadly countries with most at-risk and possibly most infected populations.
Laurie Garret of the Center for Global Development, notes that “What in reality has happened is we have had to use [certain] markers for HIV in society because we didn’t have people on the ground with the skill set, nor the political support from governments to do the kinds of door-to-door surveys, household surveys and so on that could have revealed more meaningful figures for what was actually going on with HIV/AIDS.” The UN itself recommends that more emphasis is required to strengthen systems to collect and analyze data and to improve the quality of such data to strategically guide programming.” My research has led me to enthusiastically concur on both points.
I conclude that although the significance of my results do not give strong proof that policies interacted with aid will bring AIDS relief, my findings support and now join the work of scholars who have proved that aid alone is ineffective if not detrimental to development, and “good” policies show promise for aid efficacy. Significant results argue that whether or not a country receives aid does make a difference in decreasing HIV, however a selection bias does exist and is fueled by conditions other than need. Surely, AIDS is an urgent issue and the international community must support effective prevention, treatment, and care programs. The World Bank, Global Fund, and PEPFAR programs are indeed changing people’s lives by providing necessary services and attention to HIV infected and affected communities. However the international community must also simultaneously push the UN and its organizations to put their well-researched and developed methodologies into action to engage national governments in information seeking and national surveillance, and prioritize possession of accurate and up to date information.