A modest increase in taxes on alcohol and tobacco in countries seriously affected by HIV and TB could generate enough income to cover the costs of antiretroviral treatment, TB treatment and malaria treatment and prevention, as well as reducing the incidence of non-communicable diseases caused by alcohol and tobacco, according to modeling work presented at the 19th International AIDS Conference in Washington DC.
Andrew Hill of Liverpool University said that other taxes could potentially raise millions for the global HIV response, as well as for other public health priorities.
Presenting what he dubbed a “Global Health Charge,” Hill suggested that a one U.S. cent tax per ten milliliters of alcohol (the equivalent of 2 Kenyan shillings per bottle of beer) and a 10 U.S. cent tax on a pack of 20 cigarettes (8 Kenyan shillings) could generate enough money in 10 of the 20 countries facing the highest burden of HIV to not only fund universal access, but also spur efforts to fight TB and malaria.
By considering the adult population size; annual alcohol and tobacco consumption; the cost of universal access per person per year (which he pegged at a conservative $861, a figure that includes treatment, diagnostics, and medical care); and the number of people in need of HIV treatment, Hill showed that, for example, in Kenya alone, $63 million could be raised annually, paying for 73,000 of the 277,000 Kenyans in need of ART.
If the Global Health Charge were raised only marginally higher in the Kenyan model – up to five cents on alcohol, and 25 cents on cigarettes – universal access could be achieved.
With only a one cent charge on alcohol, and a 10 cent charge on tobacco, universal access could be funded in Nigeria, Uganda, Botswana, Thailand, Vietnam, India, Brazil, Russia, Ukraine, and China. Implementing such a tax in these countries would raise a total of $2.57 billion a year, allowing 3,011,000 patients to be placed on treatment – with money left over for HIV prevention, TB, malaria, and other diseases.
In Nigeria for example, the tax would raise $1.1 billion – enough to cover the cost of treatment for just over one million people, while leaving $223 million to combat TB and malaria.
In Uganda the tax would raise $259 million – enough to cover the cost of treatment for 281,000 people.
In South Africa a tax of 3 cents on beer and 25 cents on a packet of cigarettes would raise enough to fund universal access to treatment for South Africa’s citizens.
In Cameroun, Cote d’Ivoire, the Democratic Republic of Congo, Kenya, Malawi, Mozambique, South Africa, Tanzania, Zambia and Zimbabwe the tax would raise a total of $923 million, enough to provide treatment for 35% of the people still in need of it. Higher tax rates would achieve correspondingly greater coverage.