PHA-Exch> Pepfar's AIDS prevention failure

[Claudio Schuftan]

From: Jamie Uhrig jamie at csloxinfo.com

It can be downloaded from
http://www.cgdev.org/files/15973_file_Presidential_AIDS_Policy_FINAL.pdf


Prevention Failure: The Ballooning Entitlement Burden of U.S. Global AIDS
Treatment Spending and What to Do About It
Mead Over
05/05/2008

U.S. global AIDS spending is helping to prolong the lives of more than a
million people and is widely seen as a foreign policy and humanitarian
success. Yet this success contains the seeds of a future crisis. Life-long
treatment costs are increasing as those on treatment live longer, and the
number of new HIV infections continues to outpace the number of people
receiving treatment. Escalating treatment costs coupled with neglected
prevention measures threaten to squeeze out U.S. spending on other global
health needs, even to the point of consuming half of the entire U.S. foreign
assistance budget by 2016.

This CGD Working Paper by Senior Fellow Mead Over describes the dimensions
of these problems and argues that the United States has unwittingly created
a new global "entitlement" to U.S.-funded AIDS treatment that currently
costs about $2 billion per year and could grow to as much as $12 billion a
year by 2016—more than half of what the United States spent on total
overseas development assistance in 2006. And the AIDS treatment entitlement
would continue to grow, squeezing out spending on HIV prevention measures or
on other critical development needs, all of which would be considered
"discretionary" by comparison.

Over suggests ways to substantially restructure the President's Emergency
Plan for AIDS Relief (PEPFAR) in order to avert a crisis in which Americans
would have to choose among indefinitely increasing foreign assistance
spending on an entitlement, eliminating half of other foreign aid programs,
or withdrawing the medicine that millions of people depend upon to stay
alive.  His suggestions include

  * consolidating treatment success and leveraging treatment for prevention
by making the extension of further AIDS treatment financing conditional on
success in both treatment adherence and prevention outreach;
  * shifting to a focus on prevention by underwriting male circumcision
efforts and expanding HIV testing and counseling for couples more so than
for individuals; and,
  * intensifying the effects of prevention interventions by mapping high
risk locations and targeting them with tailor-made prevention programs.

http://www.cgdev.org/content/publications/detail/15973/
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