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World AIDS Day: More Funding for HIV Cure, Global Fund, No One on ADAP Wait List

Acknowledging World AIDS Day on December 1, President Obama announced that the National Institutes of Health (NIH) would reallocate $100 million over the next 3 years towards HIV cure research and donate up to $5 billion to the Global Fund to Fight AIDS, Tuberculosis and Malaria. In other funding news, NASTAD announced last week that there are currently no people with HIV on AIDS Drug Assistance Program (ADAP) waiting lists.

The NIH funding to support studies of promising approaches to a cure for HIV will be redirected from the existing $3 billion HIV/AIDS budget, in particular from expiring research grants and funding for areas such as opportunistic infections that are less pressing in the era of effective antiretroviral therapy. Advocates expressed concern, however, about raiding funds for other important areas of HIV research such as biomedical prevention and aging.

"Important recent advances in basic and therapeutics research aimed at eliminating viral reservoirs in the body are spurring scientists to design and conduct research aimed at a cure or lifelong remission of HIV infection," according to an NIH press release announcing the funding. "Key stakeholders from academia, government, foundations, advocacy groups and industry have concluded that developing a cure for HIV is one of the most important biomedical challenges of the 21st century. This will require an extraordinary, collaborative global effort, including public-private partnerships and innovative alliances to share scientific expertise and accelerate the search for a cure."

"Although the HIV/AIDS pandemic can theoretically be ended with a concerted and sustained scale-up of implementation of existing tools for HIV prevention and treatment, the development of a cure is critically important, as it may not be feasible for tens of millions of people living with HIV infection to access and adhere to a lifetime of antiretroviral therapy," National Institute of Allergy and Infectious Diseases director Anthony Fauci said at the White House World AIDS Day event.

"We have listened very carefully to the scientific consensus of experts from within the NIH and around the world," added Jack Whitescarver, director of the NIH Office of AIDS Research. "We have been building the portfolio of HIV cure research over the past few years, and now is the time to accelerate our research focused specifically toward the goal of sustained or lifelong remission, in which patients control or even eliminate HIV without the need for lifelong antiretroviral therapy."

The Global Fund's fourth replenishment conference took place December 3 in Washington, DC. Obama announced that the U.S. would pledge up to $5 billion, matching $1 for every $2 raised from other sources.

Overall, international partners made commitments of $12 billion -- a substantial increase over the $9 billion pledged at the previous replenishment conference. One notable change is that more money is coming from low- and middle-income countries committing their own domestic funding. Total domestic funding now equals international funding from high-income countries.

"These pledges are a demonstration of global solidarity and trust to move towards ending the 3 diseases," said UNAIDS executive director Michel Sidibé. "Support for the Global Fund comes at a crucial point -- in many parts of the world we are entering into a 'make or break' point in progressing towards our goals."

According to the annual UNAIDS progress report, new HIV infections have been reduced by 33% since 2001 and AIDS-related deaths have decreased by 29% since 2005. More than 9.7 million people in low- and middle-income countries are now on antiretroviral treatment.

Obama also this week signed the PEPFAR Stewardship and Oversight Act of 2013, extending the President’s Emergency Plan for AIDS Relief for an additional 5 years. PEPFAR supports antiretroviral treatment for approximately 6 million people worldwide. The legislation, passed late last month by the House and Senate, did not specify a dollar amount.

Finally, the National Alliance of State and Territorial AIDS Directors (NASTAD) released its latest ADAP Watch on November 25, showing that there are no individuals on ADAP waiting lists in any states, for the first time since January 2008.

The number if people on waiting lists reached an all-time high of 9298 in September 2011. The last state with a waiting list -- South Dakota -- moved its remaining 11 people into its ADAP program on November 21. Alabama and Idaho also eliminated their waiting lists and lifted their enrollment caps last month, NASTAD said.

ADAPs, which are joint federal-state efforts -- are funded through the Ryan White Program. The waiting list elimination was made possible in part by fiscal year 2013 Emergency Relief Funds, which distributed $75 million to states that demonstrated financial need. This emergency funding allowed ADAPs to maintain funding despite recent sequestration cuts.

12/4/13

Sources

National Institutes of Health. NIH announces plan to increase funding toward a cure for HIV/AIDS. Press release. December 2, 2013.

J Cohen. Where Will Obama Find $100 Million for the New HIV Cure Initiative? Science Insider. December 3, 2013.

UNAIDS. UNAIDS welcomes outstanding support for the Fourth Replenishment for the Global Fund. Press release. December 3, 2013.

NASTAD. After Five Years, ADAP Waiting Lists Have Been Eliminated; Unmet Need and Funding Uncertainties Require Continued Commitment. Press release. November 25, 2013.