The newly released November-December 2009 edition of Health Affairs features a series of articles on the challenges posed by the HIV/AIDS pandemic.  The articles focus on steps policymakers can take to change the dynamics of the pandemic so that millions of lives will be saved, infections prevented, and overall costs made more affordable. Publication of the series was supported by the Bill & Melinda Gates Foundation.

In conjunction with the issue, Health Affairs has also produced a special series of policy briefs on the issues surrounding the pandemic. These briefs, also produced with the support of the Gates Foundation, are available on the Health Affairs Web site.   

Increasing prevalence of HIV infection, coupled with the current global economic slowdown, portends a drastic funding shortfall for addressing the HIV/AIDS pandemic in both the short and long run. By the year 2031, when the pandemic enters its 50th year, funding needed for developing countries could reach $35 billion annually — three times the current level, according to a paper in the journal coauthored by Robert Hecht. Even then, more than 1 million people will be newly infected each year; some 33 million people worldwide are infected currently.

The world has an opportunity to avert this bleak future, say Hecht, managing director of the Results for Development Institute, and coauthors. They predict that by investing in high-impact prevention and efficient treatment efforts, world policymakers could cut the cost of fighting the pandemic by more than half.

Other highlights include the following:

  • Stefano M. Bertozzi, HIV director at the Bill & Melinda Gates Foundation, and co-authors offer a timeline of the world’s response to the pandemic and urge policymakers to shift from the “emergency response” mode of recent years to a more effective and efficient set of initiatives today. “An emergency response is appropriate for an earthquake, but wasteful and ineffective for an epidemic that has been with us for more than twenty-five years,” they write. They urge a new focus on evidence-based prevention programs, longer-term interventions designed to change fundamental social drivers of transmission, investments in training a new generation of health care professionals and managers, and more coordinated oversight of programs characterized by modern management practices.
  • Across the board, HIV treatment programs must be restructured to maximize benefits at the lowest possible costs, according to Anil Soni of the Clinton HIV/AIDS Initiative and Rajat Gupta of the Global Fund to Fight HIV, TB, and Malaria. They urge far broader use of the most cost-effective drug regimens for treating patients with HIV/AIDS. They also urge better use of available medical personnel through such strategies as “task shifting.” For example, in Rwanda, trained nurses with some physician supervision are conducting patient consultations for HIV treatment. By reducing the demand on physicians for HIV services, the authors say, task shifting reduces costs so that money can be used to improve and expand care.
  • Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, and colleague Gregory K. Folkers call for increased global funding of a robust research agenda on everything from vaccines to new prevention modalities. They argue that new revenue sources to combat HIV/AIDS globally are needed, including investment by rich and middle-income countries whose contributions so far have been limited.
  • Although much attention has focused on the scientific obstacles to developing an HIV vaccine, the Massachusetts Institute of Technology’s Jeffrey E. Harris contends that the economic challenges are just as real. Among the issues that need to be addressed are a lack of incentives for fostering cooperation among private-sector parties and regulatory conflicts that promote public welfare but impinge on individual rights.
  • Meanwhile, Judith Auerbach of the San Francisco AIDS Foundation argues that the focus of HIV prevention needs to be broadened, from changing the behavior of individuals to enabling societal-level health promotion and disease prevention that will have positive impacts beyond HIV/AIDS. She cites cost-effective interventions — such as empowering women in poor countries and providing stable housing for the homeless — that have shown good results.
  • The global response to the AIDS pandemic aims for universal access to treatment and for pursuing every avenue for prevention. But given limited funding availability, Dan W. Brock, a professor at the Harvard School of Medicine, and Daniel Wikler of the Harvard School of Public Health assert that there is a moral imperative for shifting priorities to prevention, which ultimately will save more lives — even if such a change in course slows progress toward the goal of universal treatment access.