As part of a collaborative project between research groups in Cote d’Ivoire, South Africa and the United States, Yale researchers have published a study that quantifies the potential loss of life from HIV resulting from the Trump administration’s proposed foreign aid cuts.
Since the release of President Donald Trump’s proposed “skinny budget” in March, researchers and policy makers have been scrambling to quantify the impact that budget cuts would have on the many U.S.-funded food, health and development projects overseas. In Cote d’Ivoire and South Africa, in particular, the United States’ commitment to funding HIV/AIDS programs has played a significant role in increasing the lifespans of HIV-positive individuals as well as lowered infection rates, according to Rochelle Walensky, professor of medicine at Harvard Medical School and lead author of the study.
The goal of this project was twofold, Walensky said. First, the researchers wanted to estimate just how severe the increase in mortality and rate of new infection would be. The second portion of the study focused on the relative efficacy of different HIV/AIDS treatment programs, she said.
The study sought to shed light on which aspects of HIV/AIDS prevention and treatment should be prioritized, and conversely, where cuts should be made.
“If President Trump and Speaker Ryan and Senate Majority leader McConnell decide to make cuts to HIV programs, countries like Kenya, Zambia, Ivory Coast, South Africa are going to have to make hard choices,” said Gregg Gonsalves, a professor of epidemiology at the Yale School of Public Health and a study co-author.
The researchers used a mathematical model to predict the impacts of several distinct strategies, according to Walensky. One of those strategies reduces new patient access to antiretroviral drugs that slow the growth of HIV. Another makes cuts to viral load testing, which measures the quantity of the virus in infected individuals. After rigorous analysis, they compiled a set of strategies for South Africa and Cote d’Ivoire that would cause the least harm, Walensky said, stressing that these “less harmful” strategies would still cause significant loss of life.
While Trump’s budget cuts have been met with support among his base, the issue of combating HIV/AIDS abroad has not always been a partisan one, Gonsalves said. Both former presidents George W. Bush ’68 and Bill Clinton LAW ’73 implemented programs seeking to address the worldwide HIV/AIDS crisis.
According to David Paltiel, a Yale School of Public Health professor and a co-author of the study, cutting HIV/AIDS funding is not a financially sound decision. Paltiel said that due to existing financial commitments, funds saved today by cutting these programs are small and mostly short-lived.
“Basically, you wouldn’t save more than 30 percent of what we’re spending now,” Gonsalves said. “But you’d pay for that with up to 20 percent new infections and 40 percent new deaths in [Cote d’Ivoire and South Africa] alone.”
On the other hand, the health impact and overall damage to the nations bearing the brunt of the losses is large and long-lasting, he added, noting that in today’s interconnected world, these damages can have impacts that reach the United States.
“Intelligence sources have suggested that the HIV epidemic, if allowed to run rampant, is a force that can destabilize entire countries and political systems,” Gonsalves said. “Treating HIV is not just about ‘charity,’ it’s about creating a more stable and integrated world.”
The researchers agreed that they hope policy makers in the United States will consider the results of the study before cutting foreign aid across the board. Walensky, who has worked with politicians in the past on HIV/AIDS programs, said that the project will continue to follow the big policy developments as they arise.
According to the World Health Organization, by the end of 2016, approximately 36.7 million people were living with HIV worldwide.
Maya Chandra | maya.chandra@yale.edu