Turning the Tide Through Better Prevention: Mead Over on the AIDS Transition

Mead OverEven as the cost of treating HIV/AIDS has fallen dramatically, the number of people newly infected has remained high. What can be done to reverse this trend and finally defeat this disease? This week on the Wonkcast, I’m joined by Mead Over, a senior fellow here at the Center for Global Development and perhaps the world’s leading expert on the economics of HIV/AIDS. He has recently published two major essays, which introduce the concept of the “AIDS transition”—the point in time where the number of people living with the disease begins to fall. He argues persuasively that to reach this point, international donors must greatly strengthen incentives for effective prevention.

The AIDS Transition

“Just adopting a new paradigm, by itself, is no magic bullet for the AIDS epidemic. The litmus test of the paradigm will be whether it enables policymakers at every level—from national leaders down to the municipal authorities and from heads of donor agencies down to those who negotiate and implement project agreements—to integrate the twin goals of reducing mortality through sustained access to treatment and better preventing new infections. Any program that accomplishes one of the goals without reference to the other must be called to account. Only programs that work on both—and can show results on both—should be eligible for funding.”

-Mead Over, from "The Global AIDS Transition"

Read the Essays

- The Global AIDS Transition: A Feasible Objective for AIDS Policy
- Using Incentives to Prevent HIV Infections

“We should be very proud of the accomplishment in bringing down the numbers of AIDS deaths,” says Mead. “But the number of new infections… has not fallen enough. And so the result is we have a new take-off in the numbers of people living with AIDS.” Since 1997, he says, the number of HIV-infected people has increased by 50%, rising from around 22 million in 1997 to 33 million today.

Listen to the podcast to hear Mead explain the concept of an AIDS transition, and how donors can greatly strengthen prevention efforts, including through innovative links between prevention and treatment. For more, read Mead’s two essays (a third, on treatment, will be published in June) that explain in depth the powerful, persuasive, yet potentially controversial new paradigm Mead proposes:

  • The first essay explains the concept of the AIDS transition and makes the case for better prevention—a 10% decline in new infections, says Mead, could save $113 billion dollars in treatment costs by 2050.
  • The second essay examines the research on HIV prevention and lays out specific ways that using performance-based incentives could decrease the rate of new HIV infections, including a discussion of how the Cash on Delivery Aid approach might be applied to HIV prevention.
  • The third essay presents original estimates of the magnitude of the future fiscal burden of AIDS treatment under alternative assumptions about treatment quality and scale up and proposes policy options to harmonize the incentives among donors, recipient governments, and AIDS patients to sustain treatment quality while leveraging treatment demand for the prevention of future cases.

Have something to add to our discussion? Ideas for future interviews? Post a comment below, or send me an email. If you use iTunes, you can subscribe to get new episodes delivered straight to your computer every week.

My thanks to Wren Elhai for his very able production assistance on the Wonkcast recording and for a draft version of this blog post.