To the Editor: In their Commentary, Ms Denny and Dr Emanuel1 are correct in saying that diarrhea and other illnesses exact a terrible toll on infants and children in resource-limited settings. However, their proposal to shift funds from the President's Emergency Plan for AIDS Relief (PEPFAR) to maternal and child health programs could result in unintended adverse consequences for the women and children they seek to protect.
The bill reauthorizing PEPFAR (PL 110-293) includes a large increase for tuberculosis and malaria programs ($4 billion and $5 billion, respectively), and it authorizes $10 billion for the US contribution to the Global Fund to Fight AIDS, Tuberculosis, and Malaria over a 5-year period.2 Children experience high rates of morbidity and mortality from both malaria and tuberculosis. In addition, the bill includes important targets for strengthening health care systems, which will benefit primary care generally.
Ten percent of US AIDS funding to poor countries supports a broad range of services, including health care and nutritional support for both HIV-infected and HIV-negative orphaned and vulnerable children.3 A Rwanda study from 2007 showed that PEPFAR dollars contributed to broader health services, including reproductive health, prenatal, and pediatric services.4
Denny and Emanuel do not discuss the central reasons that intensified and specific action on HIV/AIDS remains a global health imperative. HIV/AIDS kills young adults, on whom children depend for care and support, and profoundly undermines economic development. HIV/AIDS amplifies the transmission of tuberculosis, has resulted in enormous numbers of new cases of tuberculosis among both HIV-infected and uninfected adults and children, and is fostering the spread of multidrug-resistant tuberculosis.5
The authors' comments do highlight a fundamental problem: the lack of adequate funding for global health programs generally. But the answer is not to scale back PEPFAR, which has a much broader impact than these comments acknowledge, but to greatly increase the overall amount of US foreign assistance so that all effective programs, including essential maternal and child health programs, are appropriately funded.
Financial Disclosures: None reported.
Additional Information: The writers are cochairs of the Infectious Diseases Center for Global Health Policy and Advocacy of the Infectious Diseases Society of America and the HIV Medicine Association, Arlington, Virginia.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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