Despite unprecedented growth in available resources, the world is facing both short- and long-run financial crises in combating the international HIV/AIDS pandemic.

That message emerges strongly from a cluster of articles in the November/December 2009 issue of Health Affairs funded by the Bill & Melinda Gates Foundation. HIV funding shortfalls and their potential lethal consequences have received heightened attention of late, notably in a powerful set of articles published recently by Donald McNeil of the New York Times.

As Health Affairs noted in one of several policy briefs summarizing findings and recommendations from the November/December issue, over the past six years the world has pumped nearly $52 billion into fighting the pandemic, making it possible for more than 4 million infected people to receive treatment – a number that would have been deemed unachievable only a few years ago. But even this rapid growth in treatment has not kept pace with the rate of new infections: an estimated 11 million people should be receiving treatment but aren’t, and more than 2 million people become newly infected each year.

Some clinics in Uganda and elsewhere are already not placing new patients on antiretroviral treatment because of a lack of funding, Anil Soni, CEO of the Clinton HIV/AIDS Initiative, and Rajat Gupta, chairman emeritus of the Global Fund to Fight HIV, TB, and Malaria, wrote in their article in the issue. Speaking at a Washington D.C. briefing on the November/December issue, Health Affairs editor-in-chief Susan Dentzer noted that the Global Fund for AIDS, Tuberculosis, and Malaria needed $3 billion more for its planned 2010 activities, and more than $10 billion for its next “replenishment,” or round of contributions from donors.

The long-term challenges posed by the HIV/AIDS pandemic are if anything more daunting than the short-term threats. “We’re on the verge of a looming crisis in the financing of AIDS in both low- and middle-income countries, Robert Hecht of the Results for Development Institute said at the briefing. Describing modeling work by the AIDS 2031 project, Hecht said that in 2031, the fiftieth anniversary of HIV/AIDS pandemic, on its current course the world risked facing “three times the spending that we have had in recent years, three to four times as many people on antiretroviral treatment, and yet very little if any reduction in the number of new HIV infections.”

But Hecht stressed that “this gloomy scenario is by no means inevitable.” He and his colleagues estimate that by investing in high-impact prevention and efficient treatment methods, world policymakers could cut the cost of fighting the pandemic by more than half. For more specifics on available steps to effectively combat HIV/AIDS, check out the November/December issue, the policy briefs, and the briefing.