“Tell them thank you.”
“Together, the costing study and price reductions open the door to scaling up and sustaining services for the 7 million people who currently lack access to HIV treatment. Providing treatment will save lives and help prevent the spread of HIV.”
Currently, South Africans turning 15 have a 50 percent risk of becoming infected with H.I.V. Timberg and Halperin argue that while treatment is important, prevention is even more so, and their frustration that not enough is being done is palpable. “Putting millions more people on medicine, while an urgent humanitarian priority, should not distract from the imperative of preventing new infections.”
During the pre-launch press briefing, Swaziland’s Minister of Health and Social Welfare, Benedict Xaba stated that the goal of the Soka Uncobe campaign is to reach 80% of the population of 15-49 year old males. “We want to medically circumcise approximately 152 000 Swazi males in-between the years 2011/2012. If we do reach our target we hope to save more than 88 000 people from becoming infected with HIV and reduce the burden of the disease.”
Dr Schwartländer and his team looked at ten approaches to treating and preventing AIDS, ranging from drugs, via intervening in the prostitution industry, to searching for joint savings by collaborating with other areas of international development. They then devised a computer model that attempted to show how these would play out in each of 139 low- and middle-income countries. The result (see chart 4) is that expenditure peaks at $22 billion in 2015, and drops below $20 billion in 2020. If Dr Schwartländer and his colleagues are right, therefore, the world (and this includes at least the middle-income members of the 139) needs to stump up a maximum of $6 billion more at the peak of things than it is doing now. Moreover, this extra money would, according to Dr Schwartländer’s sums, largely be offset by savings on treatment avoided—for, compared with business as usual, 12.2m infections would be averted, and 7.4m deaths.
A good example of the new integration opportunity is AIDS in children. There are around 400 000 new childhood HIV infections each year. But in the 68 countries where most child deaths occur, coverage with antiretroviral treatment for prevention of mother-to-child transmission (PMTCT) of HIV is painfully low. The independent Countdown to 2015 group estimated that PMTCT coverage was only 22% in these countries in 2010.
Without question, a big reason for the progress made in the past decade is the sums of money brought to bear by the President’s Emergency Plan for AIDS Relief (PEPFAR), created by George Bush in 2003 and expanded by Barack Obama, and by the Global Fund to Fight AIDS, Tuberculosis and Malaria, a free-standing institution in Geneva that gets money from rich countries to fund grants to needy countries. PEPFAR spent $US6.7 billion last year on AIDS treatment and prevention, the Global Fund $US1.6 billion. Together, the two provide antiretroviral therapy to about 85 per cent of the people receiving it in the developing world - about 4.7 million people in all.
Michael Specter, who wrote a Profile of Kramer in 2002, reported a few weeks ago on one breakthrough: a study showing definitively that antiretrovirals can reduce the transmission of the virus in a dramatic way. We don’t know how to make a vaccine, though, or how to completely stop people from being reckless, or politicians from being ridiculously destructive in their rhetoric, or poverty and uneven resources from being the enemy of public health. But on those fronts we can keep trying. What we will never know, though—never close to completely—is the way AIDS changed the world. Almost thirty million people have died of AIDS. What would they have done, who might their children have been, whom would they have loved?
Some 5m lives have already been saved by drug treatment. In 33 of the worst-affected countries the rate of new infections is down by 25% or more from its peak. Even more hopeful is a recent study which suggests that the drugs used to treat AIDS may also stop its transmission (see article). If that proves true, the drugs could achieve much of what a vaccine would. The question for the world will no longer be whether it can wipe out the plague, but whether it is prepared to pay the price.
