This evening at 6:30 pm I will be participating in a debate on this topic which will be webcast to the International AIDS Society meetings and to the world at large. At the World Bank’s invitation, I have agreed to join Roger England on the negative.  Our opponents representing the affirmative will be Jeffrey Sachs, well known author and director of Columbia University’s Earth Institute, and Michel Sidibé, executive director of UNAIDS.

The debate comes at an interesting time in the history of the effort to control the epidemic.  UNAIDS has just published their updated report on the epidemic in which they point with pride to treatment achievements but concede that the impact of global HIV policy on the rate of new infections is hard to discern.  The following graph from their report illustrates the problem.

Source: UNAIDS, Together we will end AIDS, 2012, p. 37

In 2001 the World Bank under then president Jim Wolfensohn committed to spend heavily to combat HIV/AIDS, eventually spending two billion dollars. In recent years, however, bank spending on the epidemic has fallen sharply, primarily because the Bank’s clients have not wanted to borrow for it. This was rational because countries could obtain virtually unlimited grant money for AIDS from the US Government’s PEPFAR program or from the Bank’s multilateral competitor in health, the Global Fund for AIDS, TB and Malaria.  But with donor funding leveling off—and the number of people needing treatment continuing to climb—the question arises whether the bank’s clients and the bank management and staff will consider HIV/AIDS is a sufficiently sound investment to be financed by World Bank credits and loans.

The recent arrival of a new World Bank president, Jim Kim (who will be speaking just ahead of the debate) makes this an especially propitious time to consider whether HIV/AIDS spending is indeed a sound investment. As the head of WHO’s campaign to expand AIDS treatment, the “3 by 5 initiative”, Kim invested a substantial portion of his career in the push to expand AIDS treatment. To what extent will his experience shape his views about whether or not spending on AIDS is a good investment?

The AIDS community seems to sense that there is a lot riding on today’s debate.  The debate organizers have filled the program with introductory remarks by speakers who can be expected to support the proposition.  And there is indeed much good news about AIDS treatment spending, some of which I have personally contributed.  So my friends have been asking me: Why did you accept the Bank’s invitation?  Do you really believe that HIV/AIDS spending is NOT a sound investment?

Although I have been working on the economics of HIV/AIDS for 25 years (since I helped a WHO team design the first HIV/AIDS plans in Kenya and Nigeria), my motivation for this work has not been to increase HIV/AIDS spending.  Rather I try to to search out, analyze and present the theory and evidence that would guide the appropriate prioritization of that spending.  Sometimes the evidence leads me to the view that an intervention should have a low priority, sometimes a high one.  As new evidence becomes available, I try to adjust my recommendations accordingly.

It’s in the spirit of this ongoing inquiry that I accepted to speak against the proposition that AIDS is a sound investment, even in a resource constrained environment. Do I “believe” the negative view?  Tune in to see if Roger and I can sway your views even a little.  And then check this space tomorrow for my thoughts on tonight’s proceedings.