The AIDS Entitlement Crisis?

Mead Over of the Center of Global Development has a new paper, identifying a problem I wrote about before (see here). Unless the U.S. government gets a handle on AIDS prevention, the extension of ARV therapy will consume a larger and larger share of U.S. foreign assistance. In effect, we have created an external entitlement for foreigners. In the worst case scenario, a disruption in our funding would consign those people to death. Right now, the political support for sustained and increased spending is strong. However, as the pricetag rises for an ever larger population of people sick enough to need ARVs, the U.S. government needs a new commitment to prevention strategies. Over emphasizes the importance of male circumcision, as I have recently in a CSIS op-ed. Here is the abstract of Over’s paper:

U.S. global AIDS spending is helping to prolong the lives of more than a million people and is widely seen as a foreign policy and humanitarian success. Yet this success contains the seeds of a future crisis. Life-long treatment costs are increasing as those on treatment live longer, and the number of new HIV infections continues to outpace the number of people receiving treatment. Escalating treatment costs coupled with neglected prevention measures threaten to squeeze out U.S. spending on other global health needs, even to the point of consuming half of the entire U.S. foreign assistance budget by 2016.

This paper describes the dimensions of these problems and argues that the United States has unwittingly created a new global “entitlement” to U.S.-funded AIDS treatment that currently costs about $2 billion per year and could grow to as much as $12 billion a year by 2016— more than half of what the United States spent on total overseas development assistance in 2006. And the AIDS treatment entitlement would continue to grow, squeezing out spending on HIV prevention measures or on other critical development needs, all of which would be considered “discretionary” by comparison.

Over suggests ways to substantially restructure the President’s Emergency Plan for AIDS Relief (PEPFAR) in order to avert a crisis in which Americans would have to choose among indefinitely increasing foreign assistance spending on an entitlement, eliminating half of other foreign aid programs, or withdrawing the medicine that millions of people depend upon to stay alive. His suggestions include consolidating treatment success and leveraging treatment for prevention by making the extension of further AIDS treatment financing conditional on success in both treatment adherence and prevention outreach; shifting to a focus on prevention by underwriting male circumcision efforts and expanding HIV testing and counseling for couples more so than for individuals; and intensifying the effects of
prevention interventions by mapping high risk locations and targeting them with tailor-made prevention programs.

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2 Responses to “The AIDS Entitlement Crisis?”

  1. I agree prevention is always the best policy. We should be working on new ways to stop the spread of the disease, rather allowing the problem to fester and grow larger.

  2. I believe that prevention is the key to stop this disease from gaining any more momentum. I also believe that prevention coupled with advancements virology/immunology can also bring hope to those infected.