In a speech on Tuesday at the National Institutes of Health, Secretary of State Hillary Clinton called for countries to work together to establish “an AIDS-free generation,” meaning virtually no children are born HIV positive, they would have a far lower risk of HIV infection when they become teenagers than they do at present, and where people who become infected with HIV are prevented from developing AIDS and from spreading the virus. These ambitious objectives seemed impossible not long ago, but recent scientific advances make the notion of an AIDS-free generation conceivable. In the speech, Secretary Clinton proposed three main HIV/AIDS interventions, all based on successful clinical trials: voluntary medical circumcision for men, drug treatment for infected pregnant women to prevent HIV transmission to the infant, and antiretroviral drugs for recently infected patients to reduce the risk that their sexual partners will contract HIV from them. Nevertheless, although the vision of an AIDS-free generation is tremendously exciting, generating sufficient funding for AIDS treatment and prevention remains a daunting task. At present, worldwide AIDS spending is about $16 billion each year. Even if only half of the 34 million infected individuals receive drug treatment by 2015, that would require worldwide AIDS spending to grow to $23 billion. Given the current state of the global economy, the challenges of increasing government contributions loom large.
Reductions in the per capita cost of treating and preventing AIDS stand to mitigate some of the economic obstacles to achieving an AIDS-free generation. As Secretary Clinton explained, it cost about $1,100 to provide antiretroviral treatment to an individual in 2004, but only $335 in 2010. Reasons for this cost reduction include “a shift to generic drugs, reaping the benefits of initial investments in health systems, and supply chain efficiencies.” The potential for new economies of scale in increasing the size of AIDS treatment and prevention efforts also seems significant. Of course, innovation rarely occurs without unintended consequences and complications. Last month, I wrote about a Lancet study that suggested that women who use long-lasting hormonal contraception are twice as likely to become infected with HIV, as were the male partners of HIV-positive women using long-lasting hormonal contraception. If this finding is accurate, the implications for HIV prevention in sub-Saharan African countries are grave: nearly 12 million women in the region rely on hormonal contraception. At present, the efforts to verify or reject the Lancet findings continue. A recent statement from the World Health Organization notes that “the weight of evidence” suggests that hormonal contraception does not increase the rate of HIV acquisition, transmission, or disease progression among the general population. Nevertheless, the organization intends to re-examine the relationship between hormonal contraception and HIV beginning in January 2012.
The economic, and scientific obstacles to an AIDS-free generation are clear. However, if various stakeholders rally behind this laudable goal, they could rewrite the previously bleak economic futures of communities devastated by AIDS around the world, but particularly in Africa. According to the October 2011 PLoS ONE article referenced in the Clinton speech, a $14.2 billion investment in antiretroviral treatment for 2011-2020 is predicted to “return $12 to $34 billion through increased labor productivity, averted orphan care, and deferred medical treatment for opportunistic infections and end-of-life care.” This potential for economic growth marks a radical departure from past economic conditions that Secretary Clinton described, in which the only growth industry in some AIDS-ravaged communities is the funeral business.