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- 12 December 2013 1:00 pm , Vol. 342 , #6164
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Want to Stop AIDS? Spend Big
18 November 2009 (All day)
A group of researchers is proposing a radical approach to halt the HIV/AIDS epidemic: Go on a spending spree. Pouring more than $60 billion into treatment, massive prevention campaigns, and condom distribution over the next 5 years—instead of slowly doling out the money over 2 decades, as is currently planned—will effectively stop the spread of the disease, according to a new model.
More than 33 million people worldwide live with AIDS. The problem is especially pronounced in South Africa and Zimbabwe, where up to 28% of the population is infected with HIV. The World Health Organization's strategy to tackle the problem in developing countries focuses on "universal access" to HIV services. This includes treating infected individuals with antiretroviral drugs, counseling at-risk groups about safe sex, and mounting advertising campaigns that inform people about the dangers of the disease.
Governments, nongovernmental organizations, and charities spend about $9 billion a year on these efforts, even though they have much more at their disposal. "Current plans are to hold most of the money in reserve and spend it slowly," says infectious-disease modeler Robert Smith? of the University of Ottawa in Canada (the question mark is part of his name). "There is a tendency for people to be conservative when there is a lot of money at stake." The Bill and Melinda Gates Foundation, for example, has made the fight against HIV/AIDS its top priority, but it is spending only $3 billion a year, a small fraction of its total $60 billion endowment.
Instead, Smith? argues that if the goal is to halt the spread of the disease, then the quickest route would be to spend all of the money pledged by private donors, countries, and NGOs right now and outgun the epidemic before population growth and the number of new infections balloons out of control.
To figure out if such a strategy would be effective, Smith? and colleagues devised an HIV/AIDS eradication model. The model divides the world into regions and predicts the number of new cases based on demographics and epidemiological parameters including infection rates, number of people treated, and resistance to antiretroviral drugs. If the HIV infection rate can be reduced by three-fifths, the team reports today in a supplement to BMC Public Health, then the prevalence of AIDS will start shrinking. "This does not mean zero cases," Smith? cautions, "but it can be a tipping point where the fight against AIDS gains unprecedented momentum."
The strategy wouldn't be cheap. Reducing the HIV infection rate by three-fifths would require putting every single HIV-infected person on antiretroviral drugs, running widespread education and awareness campaigns, and making condoms available to every man on the planet. All of these tactics are in play, "but not nearly enough," says Smith?. The total cost would come to $63 billion over 5 years. Governments, NGOs, and charities have this money at their disposal right now, says Smith?; they're just not spending it quickly enough.
"I think this is a good example of utopian modeling," says epidemiologist Myron Cohen of the University of North Carolina School of Medicine in Chapel Hill. But it gives the false impression that a solution for the HIV/AIDS epidemic is just a matter of spending money, he says, and that could discourage the development of new treatments and vaccines.
Susan Allen, a public health specialist at Emory University in Atlanta, adds that donors could get more bang for their buck by focusing on high-risk groups, such as heterosexual couples in Africa, rather than testing and treating everyone at once.