Are priorities at the United Nation’s Global Fund to Fight AIDS, Tuberculosis and Malaria all screwed up? Yes, say three public-health experts in the May Lancet, which hit the stands just as the fund released its first round of grants -- $378 million for 31 countries. Of the 28 nations to get the nod for AIDS-specific needs, 21 were grants tagged for buying HIV drugs. Africa received 52 percent of the total, with South Africa alone nabbing $25 million.

But Elliot Marseille, Paul Hofmann and James Kahn, dissenting docs at the University of California at San Francisco, seized the moment to argue that plans to devote money to African HAART may backfire by siphoning funds away from prevention -- and ultimately yielding a greater loss of life. In their Lancet cost-effectiveness study, they calculated that for every one year of life saved by treatment, 28 years of life could be saved through prevention with the same amount of money. In other words, one year of an HIVer’s life is worth 28 years of a neggie’s.

Marseille said that even if the drugs cost next to nothing, the price of properly administering them -- doing blood work, training physicians, delivering drugs -- would be “worse than wasting it...if the money is coming out of the prevention budget.”

Of the recent funding, just under half goes to “commodities and drugs,” said Mazuwa Banda, Global Fund program manager. This includes everything from HAART to condoms to bed nets for malaria.

Lamenting this Sophie’s choice between prevention and treatment, Kahn said, “It’s atrocious that the U.S. and other governments can’t put enough money into the fund to make this choice go away.” The report points out that while $9.2 billion is needed for an “adequate” response to global AIDS, less than $2 billion has even been promised -- and the U.S. is taking some of its pledge back.