Estimating Long-Term Global Resource Needs for AIDS through 2031

By 2031, the HIV/AIDS epidemic will enter its 50th year. In 1981, no one expected that the epidemic would become the challenge that the world faces today, particularly sub-Saharan Africa. Efforts to address the epidemic have increased dramatically over the last decade, but the epidemic remains. Without a change in approach, it is likely that the epidemic will still be with us in 2031.

The purpose of the aids2031 project is to ask what could be done differently today to change the path of the HIV/AIDS epidemic by 2031. This paper incorporates results from several of the aids2031 working groups to examine the costs and financial implications of changing the current approach to fighting HIV/AIDS. Four different scenarios are examined, including Current Trends (current growth patterns), Rapid Scale-up (scaling-up rapidly reaching targets by 2015), Hard Choices for Prevention (targeting prevention monies) and Structural Change (scaling-up more slowly but addressing basic structural issues). Depending on the strategic choices made today, the final resources required annually in 2031 vary between US$19 and US$35 billion for 139 low and middle income countries.

There are several factors that are important cost drivers in these scenarios. First, choosing to undertake the most cost-effective prevention interventions has significant implications for total expenditures required. If “Hard Choices” are made for prevention while maintaining full access to treatment, then the overall requirements drop to below US$19 billion annually in 2031 from US$35 billion annually, the expenditures needed in the Rapid Scale-up scenario. Second, the cost of ART is the largest single component of total costs accounting for around 20% of resource needs. Although future drug prices are uncertain they are only expected to account for about a third of ART costs, with laboratory and service delivery accounting for most of the rest. Thus even significant variations in future drug prices from our assumptions here are not likely to dramatically change the estimates of future resource need. Third, resources required for prevention are the largest of the different components; once these interventions are scaled-up and begin to change behavior, it may be possible to reduce prevention coverage, thus reducing required expenditures. Fourth, recent research indicates that significant technical inefficiencies exist in the implementation of both prevention and treatment and care interventions; if improvements can be made in the efficiency with which these interventions are implemented, there is scope for reducing the amount of resources required.

Another question asked at the beginning of this paper was whether there are “game changers” that could change the course of the HIV/AIDS epidemic by 2031. Model simulations show that even with both existing prevention and treatment interventions scaled-up fully and rapidly, the number of new infections is only reduced by 50 percent by 2031. The only true “game changers”, where the number of new adult HIV infections falls significantly below 50 percent of expected levels, is if there is either an AIDS vaccine or if there a new treatment is invented that leads to a cure.

Global & Regional Initiatives

R4D is a globally recognized leader for designing initiatives that connect implementers, experts and funders across countries to build knowledge and get that knowledge into practice.