Last week, the Global Fund, the world's largest multilateral source of financing for the fight against AIDS, made a grim announcement: its donors had cut their funding by $1.6 billion, a big enough bite out of the organization's budget that the fund would be bankrolling no new AIDS treatment projects until 2014.
The announcement casts a pall on the international community's observance of World AIDS day this week, an occasion on which, the Global Fund's problems notwithstanding, we have a great deal to celebrate. Never before have we had the abundance of tools to fight the global AIDS epidemic that we have today. Male circumcision has proven a powerful means of reducing infection -- a free circumcision service offered in South Africa's Orange Farm township, for example, reduced HIV prevalence there by 55 percent. An article published in the New England Journal of Medicine suggested that putting HIV-infected patients on antiretroviral drugs immediately after they were diagnosed dramatically reduced the risk of infecting their partners. Looking forward, although hopes for the impact of a microbicide gel to reduce infection amongst women appear dashed -- at least for the moment -- early stage HIV vaccine trials have shown 90 percent success.
Meanwhile, 33 developing countries have seen annual rates of new HIV infections drop by a quarter or more from their peak. From 2006 to 2010, the number of people in developing countries on antiretroviral drugs tripled to over 6 million. Costs for those drugs have come down markedly; antiretrovirals that went for $1,100 a year in 2004 can now be had for $335. The annual death toll from the disease plateaued in the middle of the last decade and has since begun to drop. Between 2002 and 2006, AIDS mortality in Kenya fell by 29 percent. These breakthroughs give new hope in the struggle against a disease that has devastated some of the world's poorest countries, killing 30 million people and infecting 30 million more worldwide.
But the breakthroughs don't amount to a global reprieve -- and last week's reminder of the perennial uncertainty surrounding the resources available to fight the epidemic, on top of news that donor funding for HIV/AIDS leveled in 2009 and then declined 10 percent in 2010, should be a wake-up call to focus on cost-effective responses.
Doing that requires getting our balance of treatment and prevention right. Because for all the promise of recent advances, we are not expanding treatment rapidly enough to cover the newly infected. For every new recipient of retroviral drugs, two people get infected. And while costs of treatment are dropping, they are not doing so fast enough. Today, as much as four-fifths of the cost of AIDS treatment in developing countries goes not to the drug but to the staff, health system administration costs, and testing necessary to deliver it -- costs that are harder to reduce with a technological breakthroughs.