Africa Is About To Fall Off An HIV Cliff

A new study finds that Sub-Saharan Africa needs fresh funding sources for HIV treatment and prevention, like yesterday.

Current HIV statistics for Sub-Saharan Africa are grim. The region, which makes up the bulk of the African continent, saw 1.5 million new infections in 2013. It also saw 1.1 million HIV deaths. Swaziland, an especially hard-hit nation, has a staggering HIV prevalence, with nearly a third of residents infected with the virus. Only about 40 percent of those infected across the entire Sub-Saharan expanse are receiving treatment. And the situation is only poised to get worse.

Researchers from Harvard's TH Chan School of Public Health have calculated the ongoing costs of controlling HIV in nine Sub-Saharan nations, from 2015 to 2050, and found that to maintain current (inadequate) management and treatment programs will require $98 billion in funding. That shoots to $261 billion if HIV efforts are increased. This is money the region doesn't have, setting its residents up for a very dire future if dedicated funding sources aren't found soon.

The Harvard group's work is published in the current BMJ Open in a study led by Rifat Atun, a professor of global health systems at Harvard.

"There is an ethical responsibility to continue financing for those receiving ART, and not abandon them to death."

Atun and his team looked at the funding situations for the nine nations most affected by the HIV epidemic, which together account for 70 percent of the HIV burden in Africa: Ethiopia, Kenya, Malawi, Nigeria, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe. Using tools provided by UNAIDS, they were able to model the financial needs of said nations under four different scenarios, including scaling up programs to offer antiretroviral treatment to all infected residents.

It's this scenario that involves the $261 billion price tag. The researchers suggest that this money, should it somehow materialize, will need to be "front-loaded" rather than evenly spread out over the coming years. This will help reduce HIV transmission in the near-term, which will reduce funding obligations in the long-term.

In recent years, funding for HIV treatment and management in Africa has shifted away from international donors and toward domestic sources. South Africa, for example, funds its own HIV efforts almost entirely without outside support. Kenya and Zambia are headed in the same direction.

This creates a potentially precarious situation. If HIV treatment and prevention isn't rapidly scaled upward in the immediate future ("front loaded"), nations that have struggled to get this far will be hit hard down the road. For HIV management efforts to remain sustainable, this front-loading has to happen within the next five years.

To do this, the Sub-Saharan region will need outside help, according to Atun and his group. This is the problem before us and there isn't an obvious answer. And so we are left with this conclusion, from the paper: "The problem of predictable and sustainable funding must be resolved. There is an ethical responsibility to continue financing for those receiving ART, and not abandon them to death."