Trump's proposed budget for 2018, made public in May, envisions cuts to the President's Emergency Plan for AIDS Relief (PEPFAR) program, a cornerstone of U.S. global health assistance, which supports HIV/AIDS treatment, testing and counselling for millions of people worldwide.
Should the cuts keep South Africans and Ivorians from receiving antiretroviral drugs, an additional 1.8 million HIV-infected people would die over the next 10 years, 11 researchers in America, Europe and Africa concluded, using mathematical models. The combined deaths amount to nearly 9 million years of life lost, the scientists calculated, in what they said was the first effort to put figures on the proposed cuts.
The researchers measured expected savings over the next decade, whose small scale they said raised efficacy and ethical questions. In South Africa, it would amount to some $900 per year of life lost, compared to $600 to $900 in Ivory Coast.
"We leave it to readers to draw their own conclusions about whether imposing such trade-offs on vulnerable populations accurately reﬂects how donor countries value life in recipient nations," the researchers wrote in Annals of Internal Medicine.
Savings would eventually dry up over the decade, they found, due to higher costs tied to the spread of HIV amid scaled back screening and care.
"Would the relatively small savings realised by currently proposed budget reductions be worth these large humanitarian costs?" said lead author Rochelle Walensky, a professor of medicine at Harvard Medical School.