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The number of HIV-related deaths each year is falling globally, treatment is becoming more effective and cheaper, yet the rate of new infections is still too high to reach the UN’s goal of less than 500,000 new infections per year by 2020. CGD’s work on the economics of HIV introduced the concept of the AIDS transition—the point in time when the number of people living with the disease begins to fall. Our work also models the effects and implications of policies to reduce new infections and expand treatment.
CGD and its health team express our condolences to the families of all lost on MH17. We know that many of those attending the International AIDS Conference, which starts this week-end in Melbourne, have been touched personally by the AIDS researchers and activists lost on the plane and will deeply feel their loss.
There’s no doubt that Treatment as Prevention (TasP) will receive continued emphasis at this year’s International Aids Conference (IAC), as advocates argue for aggressively expanding treatment from the 9 million worldwide currently on antiretrovirals (ARVs) to the 35 million people who are HIV infected. But at the TasP workshop in Vancouver last month the more challenging and novel topic was pre-exposure prophylaxis, or PrEP. A whole array of sessions on PrEP is already on the agenda for next week’s conference in Melbourne, and our bet is that PrEP will generate a lot of buzz – an approach with intriguing potential, but edgy downside possibilities.
Earlier this year, Uganda’s President signed into law an Anti-Homosexuality Act that strengthens penalties against gay people and defines some homosexual acts as crimes punishable by life in prison. If enforced to its full extent, the law is expected to endanger public health by handicapping HIV prevention and treatment efforts; already, the national police have raided and forced a US-supported HIV/AIDS treatment center to shut down.
UNAIDS recently convened a diverse group of experts to discuss how UNAIDS should go about estimating the post-2015 cost of the HIV/AIDS response. Participants opinions varied on most topics: whether estimates should assess the cost of treating all HIV infected people as soon as they are infected (the “Universal Test and Treat” option) or that of a less ambitious treatment policy; whether spending on poverty reduction and gender empowerment should be included in the cost estimates and, if so, on how to cost these “critical enablers.” But on one question, there appeared to be virtually unanimous agreement: donors and countries should increase the frequency, the granularity and the precision of HIV infection surveys.
Last week, PEPFAR signed a three-year agreement with the Millennium Challenge Corporation (MCC) to support efforts to promote greater host-country responsibility and ownership in the US global AIDS program.
There is a growing paradox on the US aid transparency front. The US government is simultaneously home to the world’s most open and most opaque development agencies. And the chasm between them has grown wider over the last year. That’s our main takeaway from Publish What You Fund’s (PWYF) latest Aid Transparency Index rankings of 67 major donor organizations.
Zika’s rapid spread has focused media attention on how poorly prepared both rich and less rich countries are for infectious disease outbreaks. And while it seems that we are still flailing, in fact, the international community has been trying to do better for a while. Perhaps the most significant response came in 2014 when the G7 (including the US Government) endorsed the Global Health Security Agenda (GHSA), a partnership of governments and international organizations aiming to accelerate achievement of the core outbreak preparedness and response capacities required by the International Health Regulations.
Counting the number of patients on treatment is no longer enough. For years even the friendliest critics of the global struggle against AIDS have pointed out that this metric unfairly neglects the people who are not put on treatment and then die, largely because their deaths are uncounted except in so far as they increase the treatment “coverage rate.” This diverts attention from the challenge of assuring that patients are retained on treatment and remain alive and healthy, rather than failing treatment and dying, sometimes after only a few months.
Although the Trump administration has pivoted away from global leadership in many foreign policy arenas, Secretary Tillerson’s September 19 announcement of administration support for PEPFAR’s newly released 2017 strategy is reassuring. In addition to affirming the administration’s commitment to continue PEPFAR support in all 50 previously designated PEPFAR countries, the secretary announced the intention to “accelerate progress toward controlling the pandemic in a subset of 13 countries, which represent the most vulnerable communities to HIV/AIDS and have the potential to achieve control by 2020.”
In response to both public health imperative and unprecedented political pressure, aid to fight HIV/AIDS has increased massively in recent years: global funding to combat the disease in low- and middle-income countries has more than tripled since 2001, from $2.1 billion to an estimated $8.9 billion in 2006. This paper, by Michael Bernstein and Myra Sessions, discusses the increase in aid commitments by the three main financing agencies--the President's Emergency Plan for AIDS Relief (PEPFAR), the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the World Bank's Multi-Country HIV/AIDS Program (MAP)--and the receiving countries' ability, or lack thereof, to absorb the aid. It is one in a series of analyses of the sources of funding for HIV/AIDS programs in developing countries conducted under the Center for Global Development’s HIV/AIDS Monitor.
Ten years ago – on May 27, 2003 – the President’s Emergency Plan for AIDS Relief was born with the stroke of a pen by President George W. Bush. Over the last decade, the program has experienced tremendous growth and made inroads against HIV/AIDS, TB and malaria in some of the world’s hardest hit areas. And through it all, PEPFAR managed to maintain bi-partisan support that bridged two US Administrations, six US congressional sessions, and one global economic crisis.