Ahead of the United Nations General Assembly High-Level Meeting on Ending AIDS, UNAIDS announced new investment needs to Fast-Track the AIDS response. The projected need of $26.2 billion in 2020 is down from a previous estimate of $30 billion. New findings suggest that the world can reach ambitious Fast-Track targets for preventing new HIV infections, AIDS-related deaths and discrimination with fewer resources.
“Under the Fast-Track approach the world is driving down costs quickly to close the gap between people who have services and people being left behind,” said Michel Sidibé, executive director of UNAIDS. “Urgently and fully funding and front-loading investments will save lives and lead us to ending the AIDS epidemic by 2030.”
The new UNAIDS reference document entitled Fast-Track explains improvements to the investment model with critical new inputs from the revised 2015 World Health Organization guidelines on HIV treatment. The guidelines recommend HIV treatment for all people living with HIV to reduce illness and deaths, which will increase the total cost of treatment. The guidelines also recommend streamlining care and support services that will contribute to lower costs per patient per year compared to earlier guidelines while retaining quality standards, reports unaids.org.
Other inputs include new evidence that projects lower costs for HIV medicines and supplies particularly in high burden countries that will further offset the increased investment associated with expanded treatment coverage.
Failure to Fast-Track would translate into an additional 17.6 million HIV infections worldwide and an additional 10.8 million AIDS-related deaths globally between 2016 and 2030.
“The cost of inaction is too high. We have a real opportunity to end the AIDS epidemic by 2030,” said Sidibé. “If we do not quicken the pace of action, millions of people will die needlessly. Failure to Fast-Track risks prolonging the epidemic indefinitely.”
Shared Responsibility
The report shows that countries from all economic levels will be required to invest more. To reach the Fast-Track targets, total annual international assistance for HIV must increase by $2.8 billion compared with 2014 levels. This includes an additional $1.8 billion for low-income countries and an additional $1.9 billion for lower-middle-income countries, while upper-middle-income countries’ international assistance declines.
Building on the principles of global solidarity and shared responsibility, the analysis indicates that the largest potential increase in future financing for the AIDS response could be achieved by increasing domestic health budgets, with the allocation for HIV services proportional to national disease burden. This would enable the majority of countries to finance the Fast Track approach. However, countries with the lowest income and highest burden of HIV will continue to require international support.
Investing in Communities
Data show early indications that country adoption of the Fast-Track approach is working. Greater investment in civil society and community-based service delivery is critical to the Fast-Track approach. Outreach to key populations in low- and middle-income countries should grow to 7.2% of total investments by 2020, and the estimated resource needs for community-based delivery of antiretroviral therapy should grow to 3.8% of total investment.
The UNAIDS 2016–2021 Fast-Track Strategy includes achieving the 90–90–90 treatment target for 2020 whereby 90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status are accessing antiretroviral treatment and 90% of people on treatment to have suppressed viral loads. Other targets include zero infections among children and that 90% of women and men, especially young people and people living in high-prevalence settings, have access to HIV combination prevention and sexual and reproductive health services. The targets are firmly based on an approach that leaves no one behind and that is grounded in human rights.
The new projections bring the world closer to the Sustainable Development Goal target of ending AIDS as a public health threat by 2030.
