Global challenges and opportunities in fighting HIV/AIDS and neglected diseases

Responding to the HIV/AIDS pandemic and tackling so-called neglected tropical diseases are the focus of the November/December 2009 edition of Health Affairs. The articles, by leading global health experts from around the world, show that although these challenges differ dramatically, rising to meet them could save millions of lives.

Increasing prevalence of HIV infection, coupled with the current global economic slowdown, portends a drastic funding shortfall for addressing the HIV/AIDS pandemic in both the short and long run. By the year 2031, when the pandemic enters its 50th year, funding needed for developing countries could reach $35 billion annually - three times the current level, according to a paper coauthored by Robert Hecht. Even then, more than 1 million people will be newly infected each year; some 33 million people worldwide are infected currently.

"We are staring at the face of a huge crisis," says Hecht, managing director of the Results for Development Institute in Washington, D.C. "However, we have an opportunity and an obligation to mitigate this crisis by making difficult but necessary policy choices now." He and his coauthors predict that by investing in high-impact prevention and efficient treatment efforts, world policymakers could cut the cost of fighting the pandemic by more than half.

Hecht's paper is one of a series of articles in this issue of Health Affairs devoted to the economic, political, scientific, and ethical challenges facing world policymakers in their response to HIV/AIDS treatment and prevention. The articles, supported by the Bill & Melinda Gates Foundation, focus on steps policymakers can take to change the dynamics of the pandemic so that millions of lives will be saved, infections prevented, and overall costs made more affordable.

Other highlights include the following:

* Stefano M. Bertozzi, HIV director at the Bill & Melinda Gates Foundation, and co-authors offer a timeline of the world's response to the pandemic and urge policymakers to shift from the "emergency response" mode of recent years to a more effective and efficient set of initiatives today. "An emergency response is appropriate for an earthquake, but wasteful and ineffective for an epidemic that has been with us for more than twenty-five years," they write. They urge a new focus on evidence-based prevention programs, longer-term interventions designed to change fundamental social drivers of transmission, investments in training a new generation of health care professionals and managers, and more coordinated oversight of programs characterized by modern management practices.

* Across the board, HIV treatment programs must be restructured to maximize benefits at the lowest possible costs, according to Anil Soni of the Clinton HIV/AIDS Initiative and Rajat Gupta of the Global Fund to Fight HIV, TB, and Malaria. They urge far broader use of the most cost-effective drug regimens for treating patients with HIV/AIDS. They also urge better use of available medical personnel through such strategies as "task shifting." For example, in Rwanda, trained nurses with some physician supervision are conducting patient consultations for HIV treatment. By reducing the demand on physicians for HIV services, the authors say, task shifting reduces costs so that money can be used to improve and expand care.