Foreign aid in the United States accounts for less than 1 percent of all federal spending. Despite that, several Republicans want to slash, if not eliminate, assistance to poorer nations. But a new report on the effectiveness of one aid program should make policymakers reconsider that broad approach.

A study released Wednesday showed that the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) averted 741,000 deaths between 2004 and 2008. Previous research found that PEPFAR, created in 2003 by President George W. Bush, had prevented AIDS-related deaths, although researchers did not know if those people were dying of other diseases instead. But this report shows that is no the case, according to Reuters:

Data for the new study came from surveys done with adult women in 27 African countries, including nine with PEPFAR programs. Women were asked about their adult siblings and recent deaths in their families. The researchers used that information to calculate approximately how many adults in each country were dying every year, for any reason.

In 2003, Bendavid and his colleagues found that between eight and nine out of every 1,000 adults died, both in PEPFAR and non-PEPFAR nations. Countries in the new report that weren’t part of the program included Madagascar, Liberia, Senegal and Zimbabwe.

Five years later, death rates had dropped to four per 1,000 in PEPFAR countries and declined more modestly to seven out of every 1,000 without the program. That worked out to a 16 percent lower chance of death in countries with PEPFAR between 2004 and 2008, once other factors such as a country’s overall HIV rate and wealth were taken into account, the researchers reported Tuesday in the Journal of the American Medical Association.

Despite the proven results, Mitt Romney would cut PEPFAR funds if elected president. At a New Hampshire town hall last October, Romney said he was “very reluctant to borrow lots more money to be able to do wonderful things, if those things can be done by people making charitable contributions or if other countries that are wealthy.” But as Bush said of PEPFAR last year, “We’re a blessed nation in the United States of America and I believe we are required to support effective programs that save lives.”

Romney is not always against spending or borrowing more money, however. From 2003 to 2008, Congress appropriated $18.8 billion to PEPFAR, or $3.76 billion a year. In contrast, Romney’s budget plan would increase the military budget by at least $210 billion a year over 10 years. Overall, the tax cuts in his budget would cost $10.7 trillion over the next decade.

-Zachary Bernstein

Because drug manufacturers waive their patent rights in developing nations in compliance with the President’s Emergency Fund for AIDS Relief, Americans have paid tens of thousands for the same HIV drugs that cost hundreds of dollars in Africa. The enormous cost burden — as much as $30,000 a year — makes it difficult for many HIV patients to keep up with drug regimens. But as Politico reports, a Senate subcommittee will hear a proposal by Sen. Bernie Sanders (I-VT) to help lower the costs. Sanders’ plan would offer prize money instead of patent rights to companies that make new HIV drugs, so the medication would go straight to the generic market.

Drugmakers argue that they can’t make a profit without drug patents, which lets them charge less in developing nations, but “these costs can be a huge barrier to treatment,” said Mark Harrington, executive director of the Treatment Action Group.

The hearing will also look at the challenges faced by HIV patients without access to health care:

The challenge for uninsured HIV patients has worsened during the recession, as many states have taken steps to contain costs in the AIDS Drug Assistance Programs [ADAP] funded jointly by state and federal dollars. Many patient advocates are hopeful that the health reform law will get coverage to many low-income HIV patients if it goes into effect in 2014, but they worry that patients could still face high co-pays for specialty drugs and other gaps in coverage.

Even with the discount offered through ADAP programs, Ann Lefert, policy director at the National Alliance of State and Territorial AIDS Directors, told Politico that it still costs an average of $10,000 per year for one patient. And some states have waiting lists for their ADAP programs or are taking steps to contain costs.

According to Centers for Disease Control and Prevention, nearly three out of four Americans with HIV are not receiving enough medicine or regular health care “to stay healthy or prevent themselves from transmitting the virus to others.”

In some “hot spot” U.S. cities, the HIV infection rate for African-American women is five times higher than the national rate — close to the rate in some African countries.

Researchers who conducted the study expected the rate to be higher in these urban areas, but after one year, 0.24 percent of the women in the study tested positive for HIV. That’s five times higher than the Centers for Disease Control’s previous estimate for African-American women. And the rate for African-American women surprised researchers in a field that focuses more on African-American and gay men.
The study showed that the annual rate of infection was 24 per 10,000 African-American women in six cities: Baltimore; Atlanta; Newark, New Jersey; New York City; Raleigh-Durham, North Carolina; and Washington, D.C. Nationally, African-American women’s rate is 5 per 10,000. In the Congo, it is 28 per 10,000.

“This disease is alive and well in this country,” said Dr. Carlos Del Rio, principal investigator for the Atlanta area of the study. “But this epidemic is the face of the forgotten people.” And the cities highlighted by the 2009 study, which included 88 percent African-American women and 12 percent Latina women, have high poverty rates:

“Along with the results, a lot of other statistics came out of this study,” said Dr. Sally Hodder, lead author of the study and professor of medicine at New Jersey Medical School in Newark. “Slightly more than 40 percent of the women did not know the HIV status of their last sexual partner. And more than 40 percent of our participants had an annual household income of $10,000 or less.”

And out of all the women enrolled, after a one-year follow-up, 10 had died of reasons unrelated to HIV.

“This just goes to show that women don’t just have HIV risk to worry about in these areas of the country,” Del Rio said. “I’ve had women look at me and say, ‘OK, I’m at high risk for HIV, but I’m also at high risk of getting shot.’”

Del Rio pointed out that other factors such as poverty, food insecurity, and substance abuse also increase the HIV risk. Rather than only offering information about AIDS, he said these cities also need better access to medical care for HIV screenings, substance abuse treatment, education, and job availability to lower the risk.

Dr. Patrick Chaulk, Baltimore’s assistant commissioner for HIV and STD services in the Health Department, said the city is targeting all high-risk groups in its plan to cut the HIV infection rate by 25 percent by 2015. He said much of the city’s resources go toward men because they account for two-thirds of new cases. Nationally, the CDC reports that men make up three-quarters of new cases.