Key leaders from the Uganda AIDS Commission, the Zambian National AIDS Council, the Global Fund, and the Office of the U.S. Global AIDS Coordinator came together at the Global Health Council Annual Conference to discuss and debate the future costs and challenges of financing the global response to the AIDS epidemic. The panel session, hosted by the Results for Development Institute, also marked the launch of the aids2031 Costs and Financing global synthesis report: Costs & Choices: Financing the Long-Term Fight Against AIDS.

Robert Hecht, R4D Managing Director, opened the session by sharing some of the main findings from the report. Hecht noted that under current trends in policy and resource allocation, AIDS spending could cost as much as 722 billion US dollars over the next 20 years, yet still result in 2.1 million new HIV infections in 2031. In order to understand how policy choices today could impact the future cost trajectory and epidemiological impacts the aids2031 study explored three alternative scenarious that focus on (1) rapid program scale-up, (2) resource-constrained options with focused spending on high-impact interventions, and (3) structural change aimed at shifting behaviors and cultural norms. Under these scenarios, AIDS spending is projected to range from $19 to as much as $35 billion in 2031, a sobering figure considering the funding gap already facing many low and middle income countries.

Using the aids2031 projections and recommendations to frame the discussion, R4D President and session moderator David de Ferranti kicked off the debate with a series of tough questions addressing future funding sources, areas for greater efficiency, and how national strategic plans can focus on interventions with the greatest impact. All panelists agreed that the growing “funding gap” is a major cause for concern.

Paul Bouey, U.S. Deputy General AIDS Coordinator, stated that there is a huge global need that can only be met with a comprehensive global response.

David Apuuli, Director of the Uganda AIDS Commission noted that, “The money required for treatment alone is way beyond the budgets in these countries.” In fact, the aids2031 projections show that in twenty years the cost of AIDS programs could equal as much as 4 to 5 percent of GDP in several Eastern and Southern African countries – an impossible burden for low income countries to shoulder.

There is room for cautious optimism in these discussions and projections. The aids2031 findings demonstrate that wise policy choices today could drastically reduce the number of new infections, AIDS deaths, and the overall price tag over the next 20 years. Benson Chirwa, Director General of the National AIDS Council in Zambia, urged policy makers and countries to identify the major drivers of the epidemic, and aggressively scale up targeted programs with proven effectiveness.

Similarly, Dr. Apuuli, a strong proponent of prevention programs, agreed that in order to be effective, the global community must carefully study where the new infections are coming from, who is being infected, and why.

Rifat Atun, director for Strategy, Performance and Evaluation Cluster at the Global Fund to Fight AIDS, Tuberculosis, and Malaria, added the importance of data and effective monitoring and evaluation systems. Noting that “The Global Fund focuses on results,” Atun highlighted the need for accurate figures on incidence and prevalence to establish a baseline and measure program impacts.

Donors and country leaders alike recognize the growing funding gap, the need for more targeted interventions, and the fundamental shift in thinking looking to the long term. What remains to be seen is where the money will come from, which interventions are the “right” interventions, and how existing resources can and should be shifted to focus on the populations with the greatest need. These questions, among others, are at the core of the aids2031 Costs and Financing study.

To learn more about the aids2031 findings and policy recommendations, please see the full report: Costs & Choices: Financing the Long-Term Fight Against AIDS.

• Read more about this session in the blog post at “Science Speaks”

Panelist Bios:

Dr. David Apuuli, Director General, Uganda AIDS Commission

Dr. Benson Chirwa, Director General, National AIDS Council, Zambia

Prof. Rifat Atun, Director for Strategy, Performance and Evaluation Cluster, Global Fund

Paul Bouey, Deputy Global AIDS Coordinator, Office of the U.S. Global AIDS Coordinator