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Global AIDS Funding Shake-Up
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This project tries to answer the question: if we raised an additional $10 billion over the next five years to combat HIV and AIDS in sub-Saharan Africa how could it best be spent? What are the benefits and costs of the interventions? There are six assessment papers and twelve perspective papers. This perspective paper comments on the assessment paper focusing on prevention of sexual infections, (as received in August 2011).
Since 2008 the situation has changed. AIDS is no longer at the top of the global health agenda, and indeed for most of the world this makes sense. The amount of money available rose slightly to $15.9 billion in 2009 and dropped to $15.3 billion in 2010. At best resources will be stable, at worst they may fall. The replenishment conference for the GFATM in October 2010 saw pledges fall below expectations. PEPFAR has indicated that its funding is unlikely to rise. A number of other donors have either not fulfilled their commitments or have cut back. The planned UN Non-Communicable Disease Summit in New York in September 2011 has the potential to further shift AIDS out of the spotlight. Unfortunately the nature of the disease (the long period between infection and illness) means needs are growing as more and more people become eligible for (comparatively) expensive treatment.
The RethinkHIV project comes at a critical juncture in the response to the epidemic. It is not enough to simply invest $10 billion; the key is to get the best returns. This issue is increasingly important in the light of flat-lining of resources. Unfortunately, the question we may ultimately be faced with is not how to invest additional money, but rather how to make best use of what we have. This paper looks at prevention. There is Ugandan saying that 'we should not keep mopping the floor while the tap is running'. Prevention must be at the heart of the AIDS response.
Three interventions are identified for further analysis. First biomedical: male circumcision (MC), which results in a long-term irreversible reduction in infection risk for men. Second: those HIV Testing and Counselling (HTC) campaigns which focus on individual's information on their HIV status. Behrman and Kohler (2011) state theoretical and empirical arguments suggesting that if individuals know their HIV status (and that of their spouses and other sexual partners) they will make less risky decisions about sexual behaviours and relationships. The third intervention is information campaigns (IC) through mass media and peer groups, aiming to reduce risk behaviours by providing information about the disease and prevention. The commissioning brief to the authors was to pick 'at least three of the most promising interventions' - it is troubling that they struggled to come up with just these three, but this is a criticism of HIV responses, not their work.
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