Is HIV/AIDS financing insufficient?

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Drug prices for first line medicines have dropped considerably and are expected to drop in the future. Investments made over last 20 years by international donors and countries, especially in the last ten years, have laid the foundations in many countries for health systems to sustain the services for HIV patients and expand it. Most countries can afford to budget for medicines in their national programs. Therefore, external financing for first line drugs should be discontinued and  transition strategy must be worked out so that countries assume this in their national budgets immediately. India, South Africa, Brazil, Thailand, China, and Botswana have done this. Others can follow quickly. Here are some quick facts. Drug prices have come down considerably which means treatment costs, which is approximately 40% of total program costs, will be lower. Testing kits are cheaper than ever. Costs per patients of ARTs are expected to decline by more than 50% over next 5 to 10 years. Simple interventions such as male circumcision are known to reduce HIV transmission. Adopt good practices to have a cost efficient service model. Once universal access is achieved, costs are expected to further decline because of efficiency gains, better laboratory monitoring, and community level services. Currently, donor funding pays for 80% of treatment costs in low-income countries and this is not sustainable. Cost of a year's supply for first-line antiretrovial drugs is less than $100 per year for the least expensive WHO regimen. Surely, the countries can afford this.

International resources should not be used for activities which can be easily covered by the national programs.Global investments for HIV amounted to $16.8 billion, of this $8.6 billion were invested by low-and-middle income countries. 56 of the 99 middle-income countries are funding more than half of their AIDS response. Michel Sidibe of UNAIDS is right to advocate for financial sustainability through national budgets, political commitment, and local drug production to further lower AIDS treatment costs. Integrate HIV programs in existing health and education programs so that they are cost efficient and can be sustained. For example, Family planning programs can easily include counseling for HIV prevention. Maternal health programs can easily including counseling on prevention of mother to child transmission. All education programs for youth can include discussion on HIV, safe sex, and prevention.

Billions of dollars in resources freed up can now be invested in funding second line drugs for drug resistant patients and enhancing health systems to address these complicated interventions. The costs for second line drugs is high ($500 to $600 per year) and considerable pressure must now be applied, similar to what was done for first line drugs, to bring down the prices. Some of the resources can be used to finance technical assistance to create additional capacity in health systems of poorer countries so that their health systems can continue to expand and take on the responsibilities to deal with HIV patients and new infections.

Finally, it is important for donors and UN partners to coordinate their efforts. If we can pool the resources of UN and international agencies, World Bank, Foundations,  and private donors, we have enough resources. For example, the Global Fund should work with World Bank and regional banks on a transition strategy for countries to assume financing responsibilities for drugs and critical services in their respective national health strategies. These financing institutions provide low cost loans to national programs which are gradually made part of national financing. Transition must start now. Governments must provide tax and other incentives for local drug production.

 We are not using technology and best practices sufficiently to accelerate and sustain our gains to save more lives quickly and build country systems. 8 million HIV patients are on treatment now. The 7 million that needs treatment should not be waiting another day. Over 2 million infections each year is too high when billions are spent to prevent HIV. Every HIV positive mother must get treatment to prevent mother to child transmission and this can be achieved well before 2015. We do not need more funds. We need to be smarter about investing existing resources of $8 billion with careful planning, economic analysis, proper prioritization, and lots of coordinated as well as collaborative efforts. We now need to focus on a 'Transition Strategy' with countries and this requires serious rethinking and refocussing. Forget individual donor strategies. Let us have one global strategy of transition, critical investment, and country capacity building. Focus on collaboration, integration, revised national strategy and national financing to win this battle. We need to be tough about anti discrimination law enforcement so that no one infected with HIV faces stigma and discrimination. And we need to reduce the bureaucracy in international financing institutions.

Rahman is an international health consultant and worked for international foundations and NGOs.