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A Modest Increase in U.S. Investment to Fight HIV/AIDS in sub-Saharan Africa Could Prevent 22 Million New HIV Infections by 2032
Analysis examines historical and potential impact of U.S. global health funding in region bearing heavy HIV/AIDS burden
NEW YORK, Nov. 10, 2017 – A new analysis shows that nearly 5 million lives in sub-Saharan Africa have been saved since 2003 as a result of U.S. investments in the global HIV/AIDS response. According to the analysis, if investment in global AIDS programs is increased by 10 percent, up to 22 million new HIV infections and 2.3 million deaths could be averted in the region by 2032.
Researchers at Imperial College London, amfAR, The Foundation for AIDS Research, and Friends of the Global Fight Against AIDS, Tuberculosis and Malaria examined the historical impact of U.S. global health investments and the implications of budget cuts in sub-Saharan Africa, the region that is home to 70 percent of all people living with HIV. Their findings are published online in the November 28 edition of the journal AIDS.
“As the leader in the global HIV/AIDS response, the United States has been instrumental in significantly reducing millions of AIDS-related deaths and preventing millions of HIV infections in Africa,” said Jessica B. McGillen, a research associate from the Department of Infectious Disease Epidemiology at Imperial College London and the lead author. “This analysis underscores the dramatic consequences of the U.S. not funding or reducing its commitment to fighting the epidemic."
While U.S. investment in global health programs constitutes a tiny proportion of the nation’s federal spending budget — just a quarter of one percent – the U.S. is the largest donor to the global fight against HIV/AIDS through the President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund). PEPFAR is among the most successful global health programs in history and is currently supporting 11.5 million people on lifesaving antiretroviral treatment (ART). The Global Fund is the world’s largest public-private funder for HIV, tuberculosis and malaria, and along with PEPFAR has been vital in funding treatment delivery, supporting HIV testing services, and scaling up HIV prevention services. Global Fund-supported programs have saved more than 22 million lives to date.
The Administration proposed cuts that would have decreased global AIDS funding for PEPFAR by $800 million and for the Global Fund by $225 million in Fiscal Year 2018, representing reductions of 18 and 17 percent, respectively.
A World Without PEPFAR and the Global Fund
The authors used a mathematical model of HIV transmission to evaluate the impact of U.S. support for HIV programs across sub-Saharan Africa. They sought to determine how the HIV epidemic might have progressed if the U.S. had failed to invest and how the epidemic is likely to evolve under several future U.S. funding scenarios, and to explore the impact of a shift away from key at-risk populations.
Using financial data to assess the impact of lost PEPFAR and the Global Fund contributions if the programs had never been established, the authors found that AIDS mortality rates would have continued to increase instead of dropping in the mid-2000s, resulting in 3.7 million more HIV infections by the end of 2016 and nearly 5 million more lives lost to the epidemic.
From 2017 onward, if current numbers of people on treatment are maintained without any program expansion, as has been proposed by the Administration, the model indicated that 25.7 million new HIV infections and nearly 4.4 million AIDS deaths could occur by 2032.
A stepped-up response with a 10 percent increase in U.S. funding for PEPFAR and the Global Fund, coupled with more ambitious domestic HIV spending by African countries, and a focus on optimizing resource allocation, including targeting key at-risk populations, would enable 83 percent of adults with HIV to be virally suppressed on treatment, and avert more than 22 million new HIV infections and 2.3 million AIDS-related deaths over a 15-year period, relative to no expansion of the programs.
“Deaths from HIV-related causes have been halved since 2005, and more than half of all people living with HIV are on life-saving treatment, but the epidemic is far from over,” said Alana Sharp, a policy associate with amfAR and one of the authors. “We hope this informs funding and allocation decisions for global health, because without the political will and appropriate investments, we won’t be able to do what is needed to end the epidemic.”
“PEPFAR and the Global Fund work together at the country level to drive down HIV mortality and incidence, and their exceptional results deserve continued U.S. investment,” said Chris Collins, President of Friends of the Global Fight. “Yet the fight against HIV remains underfinanced. Building on the impact we’ve seen, it’s time to accelerate the effort to save lives and end the AIDS epidemic.”
Click here for more information on the impact of U.S. investments on PEPFAR.
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About amfAR
amfAR, The Foundation for AIDS Research, is one of the world’s leading nonprofit organizations dedicated to the support of AIDS research, HIV prevention, treatment education, and the advocacy of sound AIDS-related public policy. Since 1985, amfAR has invested more than $480 million in its programs and has awarded grants to more than 3,300 research teams worldwide.