$27 Billion Boost for HIV Prevention Programs Could Avert Majority of Projected HIV Infections Worldwide
Nearly two-thirds of the HIV infections projected to occur worldwide by 2010 could be prevented if an additional $27 billion were allocated to HIV prevention programs, according to two studies released yesterday, the Boston Globe reports (Donnelly, Boston Globe, 7/5). In the first study -- published in the July 6 issue of the Lancet -- epidemiologists, demographers and mathematicians from UNAIDS, the World Health Organization, the U.S. Census Bureau and the private organization The Futures Group International created a model to predict the future of the epidemic and how new infections could be averted. The researchers predict that an additional 45 million people worldwide will become infected with HIV by 2010 but add that 29 million of these infections could be prevented if HIV prevention efforts are rapidly expanded or instituted. Such efforts include advertising campaigns, school and workplace education, condom distribution and needle-exchange programs, the study states. According to the study, while the majority of HIV infections could be averted if fully expanded programs were in place by 2005, half of the projected benefit would be lost if the projects were not in place until 2008 (Brown, Washington Post, 7/5). The researchers project that the cost of such a "concerted, global campaign" would require a quadrupling of current spending on HIV prevention. "These deaths are not inevitable. We can actually do something which can substantially decrease this epidemic," WHO epidemiologist and study co-author Dr. Bernhard Schwartlander said (Garrett, Newsday, 7/5). The model did not take treatment into account because the researchers said that there is "no research to quantify how the use of antiretroviral drugs changes population-wide transmission of HIV" (Washington Post, 7/5) Schwartlander said that "prevention and treatment efforts are intertwined, and there should not be a debate of funding one over the other."
Prevention Plan Outlined
A separate study released yesterday outlined a plan for expanding current HIV prevention programs and creating new ones. The study was drafted by the Global HIV Prevention Working Group, an independent panel of 40 "leading HIV prevention specialists" that was assembled by the Bill & Melinda Gates Foundation and the Kaiser Family Foundation (Boston Globe, 7/5). The group convened to evaluate the projections made in the other study and "determine what an all-out global HIV prevention campaign would take," Newsday reports (Newsday, 7/5). The group proposes a number of initiatives, including allowing countries to set their own priorities for funding, boosting health system infrastructure, expanding successful prevention programs, mobilizing political leadership, improving HIV surveillance and "dramatically" increasing access to treatment. To successfully achieve these goals would require an additional $4.8 billion annually by 2005 and a total of $27 billion in funding by 2010. Helene Gayle, co-chair of the working group and an official with the Gates foundation, said, "We are going to continue to face devastation if we don't as a world community wake up to this and put in the resources that we need to make the difference. By presenting some practical solutions, and some things we know are doable, it's not just saying 'Give us the money and trust us.' It's 'Give us the money ... and there are solutions available today'" (Boston Globe, 7/5).
A Washington Post editorial calls AIDS an "optional catastrophe," stating that the epidemic "may get several times worse over the next decade, or it may be brought under control" with successful prevention and treatment efforts (Washington Post, 7/5). A USA Today editorial also states that the world "can do better" at fighting AIDS by using "proven models ... and promising drugs" (USA Today, 7/5). But several AIDS officials said that the epidemic will not be wiped out so easily. Dr. Nils Daulaire, a former top health official at USAID and current head of the Global Health Council, said that the recent UNAIDS estimate that 68 million people could die of AIDS-related causes by 2020 is "conservative" and that the actual number of deaths will likely total 90 million. "When you look at the history of the projections on HIV/AIDS, almost without fail those projections turned out to be conservative projections. Ten years ago, people talked about 30 [million] to 40 million cumulative infections by 2000. The actual number was 60 million," Daulaire said. Daulaire estimated that although 90 million people could die of AIDS-related causes by 2020, a successful HIV vaccine and "more effective programs to fight AIDS" could change that estimate (Barber, Washington Times, 7/4). UNAIDS Executive Director Peter Piot also noted that it will be difficult to eradicate HIV/AIDS. "I don't think we will see, in our lifetime, the end of AIDS and of the AIDS epidemic. I think we need to start reasoning in terms of generations," he said (Reaney, Reuters, 7/4).
This week's edition of the Lancet features several other articles related to HIV/AIDS. A short listing of some of the articles appears below:
- Uganda prevention programs: New HIV infections dropped by 37% in the second half of the 1990s in Uganda, largely due to the implementation of HIV prevention programs, a study sponsored by the United Kingdom's Medical Research Council states. Uganda "shows that the fight against AIDS can be won, and that it's being done without low-cost drugs," James Whitworth, director the BMC-sponsored program in Uganda and lead study author, states (Naik, Wall Street Journal, 7/5).
- Antiretroviral treatment in Uganda: Another study evaluated the UNAIDS/Uganda Ministry of Health HIV Drug Access Initiative, a pilot antiretroviral program in which patients paid for medicines that were offered at reduced prices. The initiative "successfully expanded access to antiretroviral drugs in Uganda," and patient monitoring could help curb drug resistance, the study states (Weidle et al., Lancet, 7/6).
- Public health and AIDS in Africa: In the final installment of the Lancet's series on AIDS in Africa, Kevin De Cock, Dorothy Mbori-Ngacha and Elizabeth Marum of the CDC in Kenya argue that some HIV/AIDS prevention and treatment efforts are "poorly adapted" to Africa because the epidemic "has not been defined and addressed as an infectious disease emergency." The authors present epidemiological statistics of the disease in Africa, analyze the global response to HIV/AIDS and how it is applied in Africa, "review contradictions in approaches to the epidemic," and argue that HIV testing and partner notification policy and practices should be reconsidered (De Cock et al., Lancet, 7/6).