Rethink HIV: Strengthening Health Systems, Perspective Bärnighausen et al

Perspective Paper

The gains of the last decade are fragile, and barring new technological breakthroughs for fighting HIV, the coming decade could be very different for three reasons: (i) an expanding gap between available treatment resources and stated goals; (ii) flat-lining or declining donor support for global HIV programs; and (iii) the emergence of new demands on the global health community, such as the rise in non-communicable diseases in the developing world. The expanding gap between available and desired treatment resources comes from multiple sources: the new UN goal of achieving universal coverage by 2015 (UN, 2011b); WHO’s revised ART eligibility guidelines (from CD4 count<200/µl to CD4 count<350/µl) (WHO, 2010) which have increased the number of people needing ART worldwide from 10 to 15 million (WHO et al., 2010); and the emergence of new evidence that treatment is a highly effective form of prevention (Cohen et al., 2011, Lancet Editorial, 2011), which has led to a chorus of calls for expanding the use of ART for prevention much earlier in the progression of the disease (Economist, 2011, Sidibé, 2011, UNAIDS, 2011a). Flat-lining or declining funding is a direct result of the global financial crisis which began in 2008; and although the UN General Assembly has just pledged to close the $6 billion gap between current funding ($16 billion in 2010) and the estimated need for 2015 (UN 2011), the fulfillment of this pledge remains uncertain as the world economy continues to be buffeted by new crises in Europe, the United States and Japan. The emergence of new demands on the global health community is prominently highlighted by the UN General Assembly’s upcoming High-Level Meeting (from September 19-20, 2011) for discussing the prevention and control of non-communicable diseases worldwide with a particular focus on developing countries. Preceded by a UN General Assembly resolution reaffirming commitment to strengthening national health systems (rather than a particular disease like HIV) (UN, 2010), and a preliminary report by the UN secretary general which seeks commitment from member states to address non-communicable diseases at a priority level compatible with other diseases like HIV (UN, 2011c), this meeting has the potential to shift donor focus and energies away from HIV.

A Perspective Paper has been written by Till Bärnighausen, Assistant Professor of Global Health, Harvard School of Public Health; David E. Bloom, the Clarence James Gamble Professor of Economics and Demography; Chair, Department of Global Health and Population, Harvard University; and Salal Humair, Visiting Associate Professor, School of Public Health at Harvard University.