HIV/AIDS, tuberculosis, and malaria are three of the world’s greatest causes of morbidity and mortality.
Since the first HIV case 20 years ago, more than 60 million individuals around the world have been infected, and more than 20 million have already died from AIDS. At the beginning of the 21st Century, AIDS is the number-one cause of death in Africa and the fourth cause of death globally.1
The incidence of malaria worldwide is estimated to be 300 to 500 million cases each year, with about 90 percent of these occurring in Africa. Malaria kills between 1.1 and 2.7 million people worldwide each year, of which about 1 million are children under the age of 5 years in sub-Saharan Africa. At present, about 100 countries or territories in the world are considered malarious, almost half of which are in Africa.2
Tuberculosis (TB) kills approximately 2 million people each year. It is estimated that between the years 2002 and 2020, approximately 1,000 million people will be newly infected, more than 150 million people will get sick, and 36 million will die of TB if control is not further strengthened through better case detection and effective treatment. Every second, someone in the world is newly infected with TB.3
The health crisis faced by the developing world, created by the unchecked spread of HIV/AIDS, TB, and malaria, threatens to dramatically reverse the hard-won development gains of the last 50 years. The AIDS epidemic has been particularly devastating. The World Bank has declared that AIDS is a development crisis. In countries with prevalence rates of 20 percent or more, reductions of as much as 2.6 percent of the gross domestic product (GDP) annually are likely. The workforce of nations has been affected, weakening economies and depleting skilled workers. By the year 2020, more than 25 percent of the labor force in some sub-Saharan African countries may be lost to AIDS.4
Debt relief has been shown to be one effective mechanism to help countries in their response to health crises. Debt relief already provided to some impoverished countries has saved them a total of almost $1 billion in debt payments. As a result of receiving debt relief, several countries have stepped up spending on AIDS programs.5
Africa is most acutely affected by the AIDS crisis. An estimated 70 percent of the global total of HIV-positive people lives in sub-Saharan Africa. Since the beginning of the epidemic, more than 15 million Africans have died from AIDS; 2.2 million AIDS deaths occurred there in 2001. Africa will see life expectancies fall to near 30 years of age, levels not seen since the end of the 19th Century. With each minute that passes, another African child dies of AIDS.6
More than 34 million children in Sub-Saharan Africa are orphans, with 11 million children orphaned due to AIDS. By 2010, 5.8 percent of all children in sub-Saharan Africa will be orphaned by AIDS. In 2010, it is estimated that orphans from all causes will number 42 million, of whom 20 million will have lost one or both parents due to AIDS.7
The education sector in Africa is also threatened, as AIDS claims the lives of thousands of teachers and schools are forced to close. An estimated 860,000 children in Sub-Saharan Africa lost teachers to AIDS in 1999.8
The World Health Organization estimates that 5 to 6 million of Africans living with HIV/AIDS are in need of treatment with anti-retroviral medications. But, because of a variety of factors, including price, these medications are out of reach to them.9
An adequate response to this health crisis facing many countries, and especially the developing world, requires substantial additional effort and investments from developed and developing country governments, multilateral agencies, the private, voluntary, traditional, and academic sectors, researchers, and private foundations. The United Nations Joint Program on HIV/AIDS (UNAIDS) has estimated that up to $10 billion is needed annually to effectively respond to the global HIV/AIDS epidemic. Annual global spending on prevention falls $3.8 billion short of what will be needed by 2005.10
In April 2001, the Secretary General of the United Nations issued a call to action for the creation of a Global Fund to fight HIV/AIDS. The new Global Fund to fight AIDS, Tuberculosis, and Malaria was established in 2002. The Fund is a global public/private partnership that aims to strengthen cooperation, increase coordination, and generate greater investments aimed at these three diseases, with an overall goal of improving health outcomes. The Global Fund aims to rapidly disperse grants to augment existing spending on the prevention and treatment of AIDS, TB, and malaria.
A study by the U.S. General Accounting Office found that the Fund has made noteworthy progress in establishing essential governance and other supporting structures and is responding to the challenges that have impeded its ability to quickly disperse grants. The Fund has developed comprehensive oversight systems for monitoring and evaluating grant performance and ensuring financial accountability. The report found that the Fund’s ability to approve and finance additional grants is threatened by a lack of sufficient resources. Without significant new pledges, the Fund will be unable to support all of the approved grants beyond their initial two-year agreements.11
Within the United States, the Centers for Disease Control and Prevention estimates that the number of people living with HIV (PLWH) is increasing by 25,000 annually, and more than half of all people living with HIV are not in regular medical care. Minorities, youth, and women are disproportionately represented among them. The number of uninsured Americans has risen to 43.6 million, and state budget shortfalls are bringing about Medicaid eligibility and benefit cuts. Funding for the Ryan White Comprehensive AIDS Resource Emergency (CARE) Act and its AIDS Drug Assistance Programs has not kept pace with the need for services for un- and underinsured PLWH.
Given these facts, the American Public Health Association:
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