by Julia Shen and Angela Rastegar
Despite the progress we’ve made in the past thirty years, the HIV/AIDS epidemic is far from over. There are currently 34 million people worldwide infected with HIV, and it is estimated that there are two newly infected individuals for every one person who starts treatment using anti retroviral medication (ARVs).
At the last International AIDS Conference, ARVs and HIV medication held the spotlight, with leading experts suggesting that “treatment as prevention” could be an effective way to fight HIV. When an HIV patient uses ARVs, it can greatly reduce the chance of infection to that patient’s partner. With up to 62 to 73% efficacy, this approach could be as good as a vaccine. Similarly, high-risk populations can lower their chances of contracting the virus by taking ARVs.
However, applying these findings has been challenging, and illustrates broader barriers to creating an AIDS-free generation. Healthcare professionals can use this type of prevention – called pre-exposure prophylaxis, or PrEP – as “another arrow in the quiver,” but success has been low in real world settings. In sub-Saharan Africa, where young women have some of the highest prevalence rates worldwide, a FEM-PrEP study had to be stopped early due to poor drug adherence. HIV incidence is still growing rapidly among vulnerable communities, such as men who have sex with men and injection drug users, particularly in places such as South Asia and Eastern Europe where the disease is associated with strong stigma, which can prevent people from seeking treatment.
Deep dive: Timelines of global progress across different “arrows in the quiver” in HIV/AIDS (Click to Enlarge)
HIV continues to be a moving target, even as we find more approaches to fighting the disease. While the community has been able to mobilize tremendous resources to address the epidemic, there are still questions around the sustainability of these investments and whether or not it’s possible to continue financing the liabilities that are associated with ARVs. Recent setbacks that have reduced HIV/AIDS funding, such as the Global Fund’s partial cancellation of Round 11, have reinforced the need to double down on interventions that work, such as prevention of mother-to-child transmission (PMTCT) while testing new policy innovations such as health financing bonds.
HIV/AIDS has long been at the forefront of the development agenda in Dalberg’s Global Health practice. We often say our work spans “from the boardroom to the village,” with cases including everything from advising government leaders in East Africa on Global Fund proposals to strategic planning with senior leaders for the Global Business Coalition on HIV/AIDS, Tuberculosis and Malaria to conducting detailed, on-the-ground capacity assessments for the HIV/AIDS response in Mozambique with the UN Development Program.
Vicky Hausman, Dalberg’s Global Health practice lead, said that the importance of making AIDS as a development priority cannot be overstressed.
“AIDS has been a cornerstone of the resource mobilization for global health – and development more broadly – over the past decade,” she said. “It remains a critical health issue in many countries, and the question now becomes how to sustain momentum while evolving to a broader and more integrated agenda.”
As the theme of this year’s conference suggests, there is no turning back from the progress that has been made. It’s time for development partners to show renewed focus on “turning the tide together.” 
This is the second part of a two-blog series on HIV/AIDS by Julia Shen and Angela Rastegar. Julia is a consultant in Dalberg’s Nairobi office. Previously, she was a healthcare and pharmaceuticals consultant at Accenture, where she worked with the Medicines Patent Pool. Angela is a project leader in Dalberg’s New York office and an active member of the firm’s Global Health practice. Prior to Dalberg, she worked with the Clinton Health Access Initiative in India.
