At least 10 million HIV-AIDS deaths could be averted by 2025, but doing so requires a dramatic expansion and simplification of treatment, the man leading the international fight against the epidemic says.
"We must reshape the AIDS response," said Michel Sidibé, executive director of UNAIDS, the United Nations Program on HIV-AIDS.
That new approach, dubbed Treatment 2.0, calls for 15 million people worldwide to be treated with antiretroviral drugs that can slow the progression of HIV-AIDS symptoms - up from the five million currently undergoing treatment.
Mr. Sidibé said that ramping up treatment efforts requires several innovations, including;
» A better pill: Current treatments can be quite toxic and patients develop resistance. UNAIDS hopes to develop a "resistance-proof" medication, ideally a one-pill-a-day format;
» Better diagnostics: More than two-thirds of current treatment costs go to testing and monitoring of patients; cheaper, easy-to-use tests for viral load and CD4 count are being developed;
» Viewing treatment as a key prevention tool: Patients being treated with antiretrovirals are far less likely to transmit the virus; UNAIDS estimates that one million new infections a year would be averted if everyone was treated early.
UNAIDS officials conceded that implementing Treatment 2.0 would not be cheap: Treating 15 million people worldwide would cost an estimated $26-billion each year, even if the costs of testing are reduced. Currently, about $16-billion is being spent on HIV-AIDS drug programs.
"We're $10-billion short a year," said Paul De Lay, deputy executive director of UNAIDS.
He said getting those additional funds will not be easy in tough economic times but insisted that it is a good investment because the number of HIV-AIDS cases will fall and treatment costs will be reduced sharply. "Investments in prevention pay results," Mr. De Lay said.
Bill Gates, co-chairman of the Bill & Melinda Gates Foundation, said he endorsed the thrust of the new approach but it would take time to implement.
"Realistically, for the next few years, funding will not be going up and that's a real constraint," he said in a teleconference. "We're not going to be able to treat everyone with HIV."
Mr. Gates said the financial pressures make innovation and efficiency all the more important in the field of HIV-AIDS.
"There is a real opportunity to drive efficiency and better spending on the prevention side," he said.
For example, Mr. Gates said the best bang-for-the-buck can come from promoting circumcision in sub-Saharan Africa, the epicenter of the pandemic. He said prevention programs should also be more targeted at high-risk groups in specific countries, such as commercial sex workers in India and intravenous drug users in China.
There were an estimated 33.4 million people in the world living with HIV-AIDS at the end of 2008. In the same year, there were an estimated 2.7 million new infections and two million AIDS-related deaths, according to UNAIDS.
Bernard Schwartlander, chief epidemiologist at UNAIDS, said that while much work remains to be done, it is important to recognize how much progress has been made in recent years.
For example, five million people are now taking antiretrovirals in the developing world, up from "almost nothing" in 2002.
In 15 of 25 of the hardest-hit countries, the prevalence of HIV-AIDS has fallen by 25 per cent or more in the past decade, Dr. Schwartlander noted.
UNAIDS recommends that countries spend between 0.5 per cent and 3 per cent of their government revenues on their response to HIV-AIDS, but few countries meet that target.