More sustained financing is needed to continue global progress against HIV/AIDS. Given the current challenges to global health financing, new solutions are vital to changing the current rate of progress.
“There is a moral obligation to maintain treatment for those who need it, and considerable resources have been implicitly pre-committed to lifelong HIV treatment and care,” say the authors of a recent paper published in the PLoS Medicine journal.
More money also needs to be better spent, they argue. HIV work must be linked to health systems strengthening, a move that will both increase the reach of HIV work and support the underlying health problems that contribute to the problem.
Financing the HIV response must also be achieved without damaging investments in health systems more broadly and other development sectors that are essential for social welfare (in turn addressing a number of the barriers to scaling up the HIV response). An HIV programme may have important external benefits for sexual and reproductive health; maternal and child health; or provide the necessary health system platforms for managing chronic conditions. Similarly, investments in strengthening health systems or addressing related co-morbidities that compound HIV vulnerability or worsen treatment outcomes are critically important to individuals living with HIV. Although core HIV interventions have been demonstrated to be cost-effective, total HIV spending in sub-Saharan African countries was an estimated 19.4% of total health spending in 2007 (range: 0.7%–64.4%). This amount exceeds the relative burden of HIV disability-adjusted life years and is at least partly due to the relatively high costs of HIV treatment compared to treatment for other prevalent diseases. There remains a difference between the amount spent on the HIV response across countries with a similar GDP per capita and HIV prevalence, and more work is required to understand the optimal level of domestic resourcing for HIV, given competing health sector priorities.
There are examples of innovative financing schemes, but they face challenges. The authors recognize that overtaxing and a hyper-focus on HIV/AIDS can do more harm than good. A careful approach that applies lessons learned can ensure changes are effective.
Innovative revenue streams are currently being explored in several countries. These schemes can generate significant funds, as seen in Zimbabwe with the 3% AIDS levy deducted from businesses and formal sector workers’ salaries since 2000 . Other options, such as increased “sin taxes” on alcohol, could generate a “double dividend” by simultaneously increasing revenues and decreasing HIV-related risk behaviours . The development of social health insurance could help attract further household resources and may be an important new source of financing in middle-income countries as development assistance scales down
Read the full research paper here.