Dire Straits: Money for Treatment, Prevention for Free?

Last week, the Kaiser Family Foundation and the National Alliance of State and Territorial AIDS Directors (NASTAD) released a report of a study on the state of HIV Prevention in the U.S. This week, Drew Altman of the KFF shared his thoughts on the sorry state of spending at scale on prevention in the U.S., “despite the fact that the CDC determined in August of 2008 that the number of new HIV infections in the U.S. is 40% higher than we thought it was – at about 56,000 per year.” While Altman seemed to suggest that global health efforts are more successful at preventing HIV than the U.S. response, I would argue that the state of HIV prevention in the U.S. (especially exemplified by drastic cuts in California) provides a preview snapshot of the global situation in the very near future: with flat lined budgets and freezes on program activities, prevention is unlikely to get the funding it should for programs to be implemented at scale and with intensity. As my colleague David Wendt reported in an earlier post, the worsening financial crisis is already beginning to manifest itself in global funding budget cuts for AIDS in countries where HIV incidence is still very high. With these cuts, countries will scramble to pull together resources for treatment, an important human and political priority in the short term, but it’s less apparent how prevention will be supported both by global funders like PEPFAR and the Global Fund, and by domestic budgets for health. In these dire straits, with a continuing focus on treatment, prevention is unlikely to happen (for real success) for free.