A new HIV funding formula has failed to bring clarity and fairness to the funding of the treatment and care of people with HIV/AIDS, according to Peter Cosgrove and colleagues

A new national HIV funding formula was introduced last year after nearly a decade of inequitable funding of HIV in England.

Previously, gross disparities in levels of funding were apparent between regions. In 1999-2000 London region received (from national funds) approximately£14,350 per infected person treated.

Eastern region received£26,660, but North West and Trent attracted only£9,909 and£9,450 respectively. Patients in some poorly funded areas were, and remain, more likely to die.

2By 1998, a fair reallocation of HIV treatment funding was desperately overdue. The Department of Health convened a review of AIDS/HIV funding.

The review proposed a new formula, funding each health authority in proportion to its number of HIV-positive residents. However, since the review group disbanded, additional elements have been added to the formula. Far from correcting funding inequities, these new elements:

disguise inequalities, reward areas that have previously spent HIV funds on other services, and reduce by 21 per cent the overall amount of money available for HIV treatment and care.

In 1999-00 the amount of money available nationally for the treatment of HIV was£232.8m.

But not all of this was spent on HIV treatment. In total,£69.8m of AIDS/HIV treatment and care funds was spent on other services (£48m on genitourinary medicine).

The vast majority (£62m or 89 per cent ) of this misspend occurred in the better-funded regions - London and Eastern. In contrast, some other regions that were under funded for HIV treatment actually had to use money from other funding streams to prop up HIV treatment.

An equitable solution may have been to reallocate the£69.8m misspend to regions of the country which were severely underresourced.

But instead, the HAs that spent£69.8m of HIV treatment money on other services were allowed to retain this money in 2000-01 and, potentially, on a recurrent basis.

The£69.8m was relabelled GUM or 'other' funds, and consequently no longer appears in the total funds nationally allocated for HIV treatment.

For example, the HAs that constitute London region declared that£55.5m of their annual HIV treatment money was not actually spent on HIV treatment and care.

Of this sum,£30.4m was spent on GUM and£25.1m on 'other' issues. Now the region appears to receive only£117.6m for HIV. In reality, it also continues to receive the additional£55.5m previously labelled HIV funding but now allocated under a different title.

The repercussions of this accounting manoeuvre are dramatic. Funding distributed nationally for HIV treatment and care was instantly cut from£232.8m to£163m.

Although the government allocated an extra£21.7m for HIV treatment in 2000-01, this still leaves an overall reduction of 21 per cent in treatment funds.

Paradoxically, most of the£21.7m in new funds has been allocated to better-funded regions as these now appear worse off as a result of the relabelling exercise.

A simple comparison of HIV in the South (London, South West, South East and Eastern regions) with that in the North (North West, Trent, North & Yorkshire and West Midlands) identifies two fundamental inequalities.

First, an HIV-positive individual in the North now attracts£11,968 per year for treatment and care (including relabelled funds), while the same individual in the South attracts£14,354 - 20 per cent more. Second, for those in treatment the chance of dying from HIV is nearly 47 per cent higher for those resident in the North than for those in the South.

3Ideally, what was required for HIV services across England was a formula that began to redress the problems in some areas caused by years of underfunding. Instead, some under-resourced regions may be even further disadvantaged.The success of combination therapies in the treatment of HIV means that mortality from AIDS in England has fallen and, as a result, the number of individuals in treatment has risen sharply.

4A new national strategy for sexual health and HIV is imminent.

But some parts of the country will have to respond to the strategy under disproportionate pressure caused by years of severe financial handicap.

REFERENCES

1 Tolley K, Maynard M. Government Funding of HIVAIDS Medical and Social Care. Discussion Paper 70. Centre for Health Economics, York University, 1990.

2 Bellis MA, McVeigh J, Thomson R, Syed Q. The National Lottery: how funding variations affect survival in AIDS.HSJ. 1999: 109 (9659) 22-23.

3 Survey of Prevalent HIV Infections Diagnosed: 1999. Communicable Disease Surveillance Centre, Public Health Laboratory Service. www.phls.co.uk

4 McVeigh J, Cook P, Rimmer P, Syed Q, Bellis MA. HIV and AIDS in the North West of England. Liverpool John Moores University, Communicable Disease Surveillance Centre (North West) and North West Public Health Observatory. ISBN 1-902051-18-1. 2000.