PARIS -What would happen if the vision of the U.S. role in the global HIV response articulated by Secretary of State Rex Tillerson before Congress, and delineated in a Trump administration budget document became reality?
A modeling study presented on the last day of IAS 2017 provided a glimpse.
To do that, researchers used funding and demographic data from 18 representative sub-Saharan African countries and applied alternate global HIV response funding scenarios that included policies determining how the funding is spent. They extrapolated the results across all countries affected by U.S. funding policies. Jessica McGillen of Imperial College in London, presented the results.
What if, to begin with, the President’s Emergency Plan For AIDS Relief and the Global Fund to Fight AIDS Tuberculosis and Malaria had never been launched?
In a worst case scenario, which includes a continuation of the limited treatment coverage of 2002, the accompanying likelihood that prices for treatment would then have remained high, and allowing the continued but minimal impacts of behavioral interventions undertaken at the time, treatment would be controlling the virus in a miniscule single-digit percent of all people living with the virus by the end of 2016, about four million more people would have been infected with HIV by then, and five million more people would be dead.
But PEPFAR and the Global Fund did come about and instead, by the end of 2016, treatment was preventing transmission and illness for 38 percent of people living with the virus worldwide.
What if the continued expansion of effective interventions were to stop now, as described by Tillerson, and the Trump “Major Savings and Reforms” document? While the numbers of people on treatment would, under that scenario remain the same, as new infections occurred the percentage of people with suppressed viruses would steadily decline. And the number of people becoming infected with HIV would climb steeply each year, with, by 2030, the year currently targeted to end HIV as a global health threat instead seeing 2 million new infections. The numbers of people losing their lives to HIV, having dropped steeply, would level off, and nearly 300,000 people would die as a result of the treatable disease each year.
In contrast, McGillen showed, increased U.S. funding, accompanied by increased domestic funding in proportion to countries’ economic growth, would by 2020, put the world on track to end HIV as a global health threat in the decade to follow with HIV controlled by treatment in more than 73 percent of people living with the virus. If that funding were allocated in accordance with the best evidence of needs and effective interventions, McGillen said, deaths would drop below 200,000 by next year.
“The aim of this particular analysis is to bypass political language and political conversation and to try to provide a dispassionate scientific assessment,” McGillen said, when asked what she would tell Congress and President Trump. “But I think it’s pretty strongly in favor of continuing funding and continuing to scale up both treatment of newly infected people and prevention of new infections, and we really stand to lose a lot of recent progress if we don’t continue. The amounts of money that we’re talking about, in this analysis, at least, are small percentages of the U.S. federal budget, and I think we can fairly easily and very effectively ensure that we continue this progress.”