Number of HIV/AIDS cases in sub-Saharan Africa expected to greatly outpace resources

The number of people infected with HIV/AIDS in sub-Saharan Africa is projected to far outstrip available resources for treatment by the end of the decade, forcing African nations to make difficult choices about how to allocate inadequate supplies of lifesaving antiretroviral therapy (ART), says a new report by the Institute of Medicine. It calls for a renewed emphasis on reducing the rate of new infections, promoting more efficient models of care, and encouraging shared responsibility between African nations and the U.S. for treatment and prevention efforts, which could greatly improve prospects for 2020 and beyond.

In 2008, more than 33 million people globally had HIV/AIDS, 67 percent of whom were in Africa. In addition, more than 90 percent of the 2.7 million new infections reported that year occurred in Africa, and only half of Africans who should have received ART according to World Health Organization guidelines then in place were treated. By 2020, the number of infected people in Africa will grow to over 30 million, with just 7 million of the approximately 12 million who should be treated under current guidelines likely able to receive ART, estimated the committee that wrote the report.

The report notes that because treatment can only reach a fraction of those who need it and its costs are "not sustainable for the foreseeable future," preventing new infections should be a central tenet of a long-term response to HIV/AIDS in Africa. In the meantime, decision makers in Africa will need to expand local capacities for choosing how to allocate scarce resources ethically. Because patients requiring treatment now generally were infected years ago, policymakers can do little to reverse the short-term course of the epidemic.

"Already in Uganda and a few other nations, we don't have enough health care workers or ART to meet demands, and health centers are increasingly turning away patients who need these drugs to survive," said David Serwadda, professor and former dean of the School of Public Health at Makerere University, Kampala, Uganda, and co-chair of the committee. "There is an urgent need for African countries and the U.S. to share responsibility and initiate systematic planning now for the future. If we don't act to prevent new infections, we will witness an exponential increase in deaths and orphaned children in sub-Saharan Africa in just a couple of decades."

The report says that despite increasingly more affordable ART drugs and the tremendous success of the U.S. President's Emergency Plan for AIDS Relief in galvanizing global efforts to fight HIV/AIDS, the gap between infections that require treatment and availability of treatment resources continues to grow and could persist for decades to come. The lack of trained health care workers, for example, already is impacting many African nations' abilities to provide care. In addition, the global financial crisis presents significant challenges to the U.S. and other donor nations in maintaining current levels of support for treatment and prevention in the region, making it essential that African governments take up their share of the responsibility.