With rigorous economic research and practical policy solutions, we focus on the issues and institutions that are critical to global development. Explore our core themes and topics to learn more about our work.
In timely and incisive analysis, our experts parse the latest development news and devise practical solutions to new and emerging challenges. Our events convene the top thinkers and doers in global development.
Expert Proposes "AIDS Transition" as Hopeful New Goal for Global Response to Epidemic
November 16, 2011
WASHINGTON, D.C. (November 16, 2011) — Ending the AIDS pandemic requires a new international goal—an AIDS transition—that focuses on reducing the number of new infections below the number of AIDS deaths so that the total number of people with HIV/AIDS declines, according to a new book by one of the world’s leading experts on the epidemic.
Achieving an Aids Transition: Preventing Infections to Sustain Treatment, by Mead Over, a senior fellow at the Center for Global Development, urges that funders and countries affected by the epidemic re-orient their policies around this goal, for example, by setting targets and tracking progress in reducing the number of new infections, and projecting an AIDS transition date, when the number of people living with AIDS begins to fall.
Despite the billions of dollars spent on the disease, the number of people infected has continued to climb. In recent years, about 1.8 million people have died each year from AIDS-related illnesses. Meanwhile, 2.6 million people become newly infected. So each year an additional 800,000 people are HIV positive, according to the book.
About 33 million people are now infected with the Human Immunodeficiency Virus, roughly twice as many as 15 years ago, when the international community began to organize against the epidemic. Of the 16 million whose disease has progressed to the point where they should be receiving treatment, only six million are receiving the medicines they need. With record deficits in rich countries, the chance of further funding increases is dim.
“The escalating number of people infected with HIV/AIDS is far outpacing available funding for treatment, especially in Africa,” says Over. “Only by holding deaths down and preventing new infections will the total number of people with HIV decline and an AIDS transition be reached.”
“Instead of reaching vainly for the unsustainable goal of offering treatment to everyone in the developing world who needs it, donors should aim to sustain current treatment levels while reducing the number of new infections below the number of AIDS deaths, so that the total number of people with HIV/AIDS declines,” he said.
Over argues making an AIDS transition an explicit goal of the international response to the epidemic would result in changes at many levels, for donor agencies, recipient countries and even health practitioners. Among these changes:
AIDS treatment programs should project not only the number of lives a program will extend, but also the number of infections it will avert.
HIV prevention programs should demonstrate that they are cost-effectively reducing the number of new infections, thereby freeing financial resources for treatment.
In each recipient country, a national AIDS planner should coordinate plans for treatment and prevention, and project an AIDS transition target date when new infections will fall below AIDS mortality.
Donorsshould shift resources into measuring new infections, a neglected area, to provide a baseline against which prevention improvements can be compared.
Achieving an AIDS Transition will be released at the Center for Global Development on November 16.
Paul Farmer, founder of Partner’s in Health, an organization well-known for its work in Haiti, and for advocating for providing AIDS treatment to poor people, says the book offers “prudent, detailed plans that promise to bring us all closer to a transition long overdue.”
Paul Collier, author of The Bottom Billion, says: “Living with AIDS is clearly better than dying with AIDS. But the best outcome is to return to an AIDS-free world. Mead Over’s book provides the essential foundation for understanding the transition.”
Peter Piot, the former executive director of UNAIDS, said that the book meets “an urgent need to take a long-term view on AIDS.”
During the early years of this century, international funding for HIV/AIDS grew rapidly. In the United States, President George W. Bush established the President’s Emergency Plan for AIDS Relief (PEPFAR), which was soon delivering billions of dollars each year to African countries hit worst by the epidemic. The G-8 countries also established a new international institution, the Global Fund for HIV/AIDS, Malaria and Tuberculosis, which provided billions more.
The funding greatly increased the number of people on treatment but failed to halt the spread of the disease. Meanwhile, rising debt and deficits in the rich countries mean that international AIDS funding has been held flat in recent years—and pressure to cut it is mounting.
Development experts also worry that AIDS funding accounts for an overly large share of total foreign aid, squeezing out funding for other health challenges, such as malaria and TB, and other issues, including infrastructure and education. Rich countries annually provide roughly $120 billion in Official Development Assistance (ODA), of which Over says that $7 billion is devoted to HIV/AIDS. In contrast, all ODA for education is only about $12 billion.
How will donors respond to these pressures?
“One possible future is that donors will turn away from AIDS, reducing their budget allocations and expenditures year-by-year,” warns CGD president Nancy Birdsall.
“This would spread despair among people suffering from HIV and it would have implications for foreign assistance more generally, if tax payers in rich countries conclude that foreign assistance doesn’t deliver and never ends,” she says.
A better approach, she says, is for donors and governments to adopt the AIDS transition as an explicit goal. This could, for example, open the way for donors to use some portion of AIDS funding to pay governments directly for measured reductions in the number of new infections.
Over’s proposal for an AIDS transition, Birdsall says, “is a hopeful alternative to the abandonment that otherwise might light ahead.”
Notes for Editors:
*Members of the media interested in attending the book launch at the Center for Global Development (1800 Massachusetts Ave, NW) on November 16, 2011 at 4pm please RSVP to media relations coordinator Jessica Brinton at Jbrinton@cgdev.org.
Mead Over Author of Achieving an Aids Transition Book: Mead Over is a senior fellow at the Center for Global Development researching economics of efficient, effective, and cost-effective health interventions in developing countries. Much of his work since 1987, first at the World Bank and now at the CGD, is on the economics of the AIDS epidemic. In addition to his new book, Over is the co-author of, Confronting AIDS: Public Priorities for a Global Epidemic (1997,1999) and The Economics of Effective AIDS Treatment: Evaluating Policy Options for Thailand (2006).
The Center for Global Development works to reduce global poverty and inequality through rigorous research and active engagement with the policy community to make the world a more prosperous, just, and safe place for us all. The policies and practices of the rich and the powerful—in rich nations, the emerging powers, international institutions, and global corporations—have significant impacts on the world’s poor people. CGD aims to improve these to expand opportunities, reduce inequalities, and improve lives everywhere. As a nimble, independent, nonpartisan, and nonprofit think tank, the Center combines world-class scholarly research with policy analysis and innovative outreach and communications to turn ideas into action.