Up to $42 billion will need to be found by 2010 if universal access to HIV treatment, prevention and care is to be achieved in line with the 2005 commitment by G8 governments, UNAIDS said today.
UNAIDS’ estimate has been developed ahead of an international meeting to win increased donor commitments to the Global Fund to Fight AIDS, TB and Malaria which starts today in Berlin. The Fund currently accounts for one-quarter of all international donor expenditure on AIDS.
Civil society advocates are calling for donors to pledge $18 billion to the Global Fund between 2008 and 2010. Current expectations are of pledges of around $8 billion from the Berlin meeting.
The UNAIDS estimates are based on an ideal scenario in which all countries implement UNAIDS-recommended interventions and WHO prevention and treatment guidelines. UNAIDS has calculated the cost of each intervention based on the populations in need in low and middle-income countries. The costs were then checked by experts from thirteen countries accounting for 55% of the financial need.
The cost of scale-up is estimated for three scenarios: one in which all countries are able to reach the universal access target by 2010, and another in which countries take longer to reach the target, but do so by 2015.
In the first scenario, to achieve universal access by 2010, available financial resources must rise to $42 billion in 2010, and to maintain it, must reach $54 billion by 2015.
To achieve universal access, treatment coverage would need to increase from current coverage to 80% of those in need, ensuring timely administration of antiretrovirals to 13.7 million people in 2010 and to 21.9 million in 2015. It is estimated that universal access will require that 1.5 million teachers be trained, 13 million sex workers reached, 10 billion condoms provided, 2.5 million circumcisions performed, and 19 million orphans and vulnerable children supported.
In the second scenario, which assumes that countries will continue to scale-up at different rates, available financial resources must rise to $28.4 billion in 2010 – almost triple the amount currently available – and $49.5 billion by 2015.
The second scenario, said Paul De Lay of UNAIDS, is based on national target-setting exercises.
“Now that we have a lot more data about how countries are scaling up…what are countries themselves saying they can do?” said Paul De Lay.
According to UNAIDS, examples of what can be achieved when countries set targets can be startling. Kenya is projected to reach 80% coverage of antiretroviral treatment by 2010 as a result of requiring local health districts to establish and achieve enrolment targets within 100 days.
Ethiopia is expected to achieve 70% coverage by 2010, partly as a result of recruiting and training 50,000 community health workers.
Even the secondary goal is very ambitious compared to current rates of scale up, said Michel Sidibe of UNAIDS. “It’s almost a doubling compared to the current pace,” he told journalists in a press call yesterday.
Under the phased scale-up, 8.2 million individuals would be treated by 2010 and 18.6 million by 2015; this would represent 80% of the three-year need for ART. Approximately 8.4 billion condoms (male and female) would be distributed by 2010; 6.3 million orphans would have been supported; 30 million patients with sexually transmitted infections would have been treated; and 2.5 million persons would receive palliative care and treatment for opportunistic infections.
“If current trends continue, the gap between resources available and resources needed to achieve global objectives will widen each year through 2015,” the UNAIDS report states. “Unless the pace at which funding is increasing accelerates, the world will fail to achieve universal access – either in 2010 or in 2015.”
Michel Sidibe of UNAIDS said that had the world made better investments ten to 20 years ago in strengthening health systems and prevention, much smaller amounts would be required today.