Although HIV/AIDS in developing countries requires "continued attention" and preventing deaths from the disease remains "imperative," other public health needs should not be "ignored," Daniel Halperin, a researcher at the Harvard School of Public Health, writes in a New York Times opinion piece.

According to Halperin, the "well-meaning promises" of some 2008 presidential candidates to nearly double U.S. aid to fight HIV/AIDS worldwide is "missing the mark." Spending more than $50 billion on foreign health assistance "does make sense, but only if it is not limited to HIV/AIDS programs," Halperin writes. He adds that in many developing countries, access to clean water is "inadequate," while shortages of food and basic health services -- including vaccinations, prenatal care and family planning -- have contributed to larger families, as well as high child and maternal mortality. Large donors -- including the President's Emergency Plan for AIDS Relief and the Global Fund To Fight AIDS, Tuberculosis and Malaria -- have not "directly addressed such basic health issues," according to Halperin.

Halperin writes that in Botswana, much of the funding from PEPFAR and other donors "remains unspent" as its HIV clinics "cannot absorb such a large influx of cash." He adds that in Africa, there is "another crisis exacerbated by the rigid focus on AIDS: the best health practitioners have abandoned lower-paying positions in family planning, immunizations and other basic health areas in order to work for donor-financed HIV programs."

The "AIDS experience" has shown that developing countries can make complex treatments, such as antiretroviral drugs, accessible to many people, Halperin writes. He adds, "Regimens that are much simpler to administer than antiretroviral drugs -- like antibiotics for respiratory illnesses, oral rehydration for diarrhea, immunizations and contraception -- could also be made widely available." According to Halperin, it is "important, especially for the U.S., the world's largest donor, to re-examine the epidemiological and moral foundations of its global health priorities." Halperin concludes that the "real-world needs" of Africans -- including the "ubiquitous ravages of hunger, dirty water and environmental devastation" -- should not be "subsumed by the favorite causes du jour of well-meaning yet often uninformed Western donors" (Halperin, New York Times, 1/1).

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