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Donor Assistance to the Developing World Should Recognize that Prevention Is the Only Sustainable, Ethical Way to Control AIDS, Say Leading International Development Scholars

NEW YORK, NY (11 June 2010) — In the current issue of Science Population Council distinguished scientist and vice president John Bongaarts and Center for Global Development’s senior fellow Mead Over offer sobering opinions on AIDS program funding in the developing world. 

According to the authors, the growth of the cost of universal access to AIDS treatment is financially unsustainable because two to three new HIV infections occur for every new patient put on treatment. The rapid expansion of treatment cost has made the current allocation of health assistance to developing countries far from optimal. Resource allocation to a particular disease could be expected to be roughly proportional to the potential ill health averted by those expenditures. However, as of 2007, 23 percent of development assistance is allocated to AIDS programs, but the proportion of deaths attributable to AIDS is less than 5 percent. 

In this article Bongaarts and Mead suggest that donor organizations should prioritize the most cost-effective interventions when determining health assistance to developing countries. Yet the authors note that antiretroviral therapy (ART) for AIDS treatment is one of the least cost-effective of the health interventions that they compared. The overall objective of international donors should be transition to an HIV/AIDS policy that preserves recently achieved mortality reductions while lowering the annual number of new infections to less than the annual number of AIDS deaths. 

"Donors should continue to expand support for treatment," says Bongaarts. "But this needs to be done at a somewhat slower pace than in the past in order to allocate an increasing share of resources to HIV prevention and to other more cost-effective health interventions."

According to Population Council HIV and AIDS program director and vice president Naomi Rutenberg, "HIV is often a disease of the highly vulnerable, and it can be more expensive to reach and treat these individuals. But that does not mean we should give up. Policies regarding allocation are a delicate balance between rationally deploying resources and protecting the safety net of the most vulnerable. We have an obligation to use the AIDS resources wisely. Prevention is the only way out of the epidemic, and we must use funding to develop better prevention methods and technologies and more integrated and higher-quality health systems."
 

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Bongaarts, John and Mead Over. 2010. "Global HIV/AIDS policy in transition," Science 328: 1359–1360.

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