Robert Hecht

Defeating AIDS—advancing global health

After more than a decade of major achievements the AIDS response is at a crucial juncture both in terms of its immediate trajectory and its sustainability as well as its place in the new global health and development agendas. In May 2013 the UNAIDS-Lancet Commission -- a diverse group of experts in HIV health and development young people people living with HIV and affected communities activists and political leaders -- was established to investigate how the AIDS response could evolve in a new era of sustainable development. The UNAIDS-Lancet Commission has come together at a moment when the lessons of the AIDS response including its whole-of-society perspective can be informative and even transformational for other spheres of global health. The path to ending AIDS as a public health threat by 2030 as set out in this report should be a major part of the post-2015 development agenda. On the basis of our analysis and discussion we make the following seven key recommendations: Urgently escalate AIDS efforts get serious about HIV prevention and continue expanding access to treatment; Mobilise more resources spend efficiently and emphasise sustainability; Demand robust accountability transparency and better data; Forge new paths to uphold human rights and address criminalisation stigma and discrimination; Reinforce and renew leadership and engagement of people living with HIV; Invest in research and innovation in all facets of the AIDS response; and Promote more inclusive coherent and accountable governance for AIDS and health. In conclusion the question is no longer whether the fight against AIDS can be won; the only questions are: will it be won -- and when? The answers to these questions will eventually depend on the decisions made by leaders and institutions at all different levels in all sectors and parts of society and on the personal choices people make in their private lives. (Excerpts)

Financing of HIV/AIDS programme scale-up in low-income and middle-income countries, 2009-31

As the global HIV/AIDS pandemic nears the end of its third decade, the challenges of efficient mobilisation of funds and management of resources are increasingly prominent. The aids2031 project modelled long-term funding needs for HIV/AIDS in developing countries with a range of scenarios and substantial variation in costs: ranging from US

Critical Choices In Financing The Response To The Global HIV/AIDS Pandemic

397 to

Economic Returns to Investment in AIDS Treatment in Low and Middle Income Countries

722 billion globally between 2009 and 2031, depending on policy choices adopted by governments and donors. We examine what these figures mean for individual developing countries, and estimate the proportion of HIV/AIDS funding that they and donors will provide. Scenarios for expanded HIV/AIDS prevention, treatment, and mitigation were analysed for 15 representative countries. We suggest that countries will move in increasingly divergent directions over the next 20 years; middle-income countries with a low burden of HIV/AIDS will gradually be able to take on the modest costs of their HIV/AIDS response, whereas low-income countries with a high burden of disease will remain reliant upon external support for their rapidly expanding costs. A small but important group of middle-income countries with a high prevalence of HIV/AIDS (eg, South Africa) form a third category, in which rapid scale-up in the short term, matched by outside funds, could be phased down within 10 years assuming strategic investments are made for prevention and efficiency gains are made in treatment.

Improving Health R&D Financing For Developing Countries: A Menu Of Innovative Policy Options

The AIDS pandemic will enter its fiftieth year in 2031. Despite much progress, there are thirty-three million infected people worldwide, and 2.3 million adults were newly infected in 2007. Without a change in approach, a major pandemic will still be with us in 2031. Modeling carried out for the AIDS 2031 project suggests that funding required for developing countries to address the pandemic could reach

Putting It Together: AIDS and the Millennium Development Goals

35 billion annually by 2031-three times the current level. Even then, more than a million people will still be newly infected each year. However, wise policy choices focusing on high-impact prevention and efficient treatment could cut costs by half. Investments in new prevention tools and major behavior-change efforts are needed to spur more rapid advances. Existing donors, middle-income countries with contained epidemics, philanthropists, and innovative financing could help bridge the likely funding gap.

Swimming Against the Tide: Strategies for Improving Equity in Health

Since the early 2000s, aid organizations and developing country governments have invested heavily in AIDS treatment. By 2010, more than five million people began receiving antiretroviral therapy (ART) – yet each year, 2.7 million people are becoming newly infected and another two million are dying without ever having received treatment. As the need for treatment grows without commensurate increase in the amount of available resources, it is critical to assess the health and economic gains being realized from increasingly large investments in ART. This study estimates total program costs and compares them with selected economic benefits of ART, for the current cohort of patients whose treatment is cofinanced by the Global Fund to Fight AIDS, Tuberculosis and Malaria. At end 2011, 3.5 million patients in low and middle income countries will be receiving ART through treatment programs cofinanced by the Global Fund. Using 2009 ART prices and program costs, we estimate that the discounted resource needs required for maintaining this cohort are

Improving the implementation of cost recovery for health: lessons from Zimbabwe

14.2 billion for the period 2011–2020. This investment is expected to save 18.5 million life-years and return

Overcoming challenges to sustainable immunization financing: early experiences from GAVI graduating countries

12 to

Financing vaccinations - The South African experience

34 billion through increased labor productivity, averted orphan care, and deferred medical treatment for opportunistic infections and end-of-life care. Under alternative assumptions regarding the labor productivity effects of HIV infection, AIDS disease, and ART, the monetary benefits range from 81 percent to 287 percent of program costs over the same period. These results suggest that, in addition to the large health gains generated, the economic benefits of treatment will substantially offset, and likely exceed, program costs within 10 years of investment.