Politics and Policy of HIV/AIDS

The Economist has a great story on the replenishment process for the Global Fund that is happening in Berlin. I am a big supporter of treatment, but here is the nub of the issue, which gets back to the notion of an open-ended lifetime entitlement that Western donors are providing for those infected with HIV.

The problem with AIDS is that the more successful you are at treating it, the more you end up paying. That is because, unlike malaria and tuberculosis, it is incurable. Once someone is infected with HIV, the virus that causes it, they will end up requiring treatment for life.

UNAIDS has a new report that examines three possibilities for expanded coverage for treatment, looking at modest expansion of current rates (8 million people by 2015, universal access by 2010 for 14 million, or universal access by 2015). The price tag is pretty high.

Scaling-up at current rates. This approach would require between US$ 14 to US$ 18 billion and would provide treatment for 8 million people by 2015.

Universal Access by 2010. This approach envisages significant increases in available resources and an urgent and dramatic scale-up of coverage in all countries. The approach would provide treatment for 14 million people by 2010 and would require between US$ 32 to US$51 billion. In 2015 the approach would require between US$ 45 and US$63 billion.

Phased scale-up to 2015. This approach assumes different rates of scale-up for each country based on current service coverage and capacity, with the achievement of different programmatic targets at different times and the achievement of universal access by all countries by 2015. The approach would require between US$ 41 and US$ 58 billion in 2015.

Cheap by Iraq War standards, but expensive when you think about what donors provide for global public health. The additional $32bn-$51bn a year is more than twice than busines as usual for the extra 6mn people. This year, $10bn will be spent so gearing up to $32bn or more is going to be some tough sledding.Fortunately, some money will come from middle income countries like Brazil who will finance much of their country’s own efforts to deal with the problem, so it’s not all donor dependent.

That said, the level of external resources is pretty amazing. I’m surprised by the continued commitment, but the political support in the U.S. and the UK is pretty deep and broad. With both the G8 meeting and the replenishment conference being held in Berlin, Germany’s new Merkel government has started to change its tune. In the UK, Gordon Brown, has already announced a £360mn (about $720mn) over 2008-2010, which is about half of what activists wanted. On the other hand, it’s still about $300mn more than what the UK pledged in the period 2005-2007 when it pledged $437mn.

I’ll post some new stuff soon about the other pledges from other donors. We need to come to grips with prevention strategies that work, lest this unmet need for ARV therapy for people continues to climb inexorably.

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Filed under: Politics and Policy