New “AIDS transition” paradigm calls for linking HIV treatment money to prevent

4.7
 New “AIDS transition” paradigm calls for linking HIV treatment money to prevent

For every two people placed on treatment for HIV, five people are newly infected. Paying for all the new people who require daily antiretroviral treatment in

For every two people placed on treatment for HIV, five people are newly infected. Paying for all the new people who require daily antiretroviral treatment in PEPFAR’s 15 target countries would by 2016 absorb half of U.S. foreign aid.

Mead Over, of the Center for Global Development, calls this unsustainable and in a new essay proposes a new paradigm for combating AIDS revolving around inducing an “AIDS transition” as quickly as possible.

The AIDS transition is an epidemiological term and not a political one. Over defines it as a dynamic process that holds AIDS mortality down while lowering the number of new infections even further so that the total number of people living with HIV/AIDS shrinks.

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The transition will be “achieved” when the number of new infections in a population crosses below the number of deaths.

What’s most unique about Over’s proposal (in my opinion) is that he wants this concept to inform donor funding so that new investments in treating HIV patients would be tied to a country’s progress in averting new infections.

“Under this approach, programs cannot be deemed successful unless they provide evidence that they simultaneously suppress AIDS mortality and reduce the growth rate of the number of people living with HIV/AIDS,” he writes.

“Any program that accomplishes one of the goals without reference to the other must be called to account. Only programs that work on both – and can show results on both – should be eligible for funding.”

By failing to link treatment and prevention, Over says, major programs like PEPFAR missed a strategic opportunity to structure its AIDS assistance to more effectively motivate recipients to work toward an AIDS transition.

What about patients and advocates who object to linking treatment funding to measured success in prevention programs? Over says that objection would be “compelling if financial and manpower resources were sufficient to treat an unlimited number of patients.

However, in the current environment, with budget shortfalls and belt-tightening everywhere, it is clear that AIDS treatment resources will be rationed whether or not we like it.”

Over is skeptical that the transition will occur by 2025. Unless an effective vaccine is produced, he says the history of prevention is a grim story leaving little to be hopeful about.

Over points to the Avahan AIDS Initiative’s intensive management strategy to implement best practices in behavioral intervention as a model so long as it remains highly context specific.

He points to scaling up male circumcision and calls for more rigorous research to figure out what prevention efforts actually work, but doesn’t spend much time on prevention except for how its success or failure influences his models of future number of people living with HIV and the associated costs.

He alludes to future essays on this topic and I hope one delves deeper into the issues of prevention.

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