Saving money, losing lives

Analysis by David Paltiel, professor at Yale School of Public Health and a visiting professor at the Laboratory for Interdisciplinary Evaluation of Public Policies (LIEPP) at Sciences Po.

Recent cutbacks in global funding for HIV/AIDS force donor nations to confront how little they are willing to give up to save a life on another continent. For the last two decades, global assistance programmes have enjoyed robust support and remarkable success in providing HIV/AIDS prevention and treatment services in resource-limited settings.
Recently, however, there are signs of funder fatigue and mounting political resistance. In 2016, for example, donor government funding to support HIV efforts in low- and middle-income countries decreased for the second consecutive year, from US$7.5 billion to US$7 billion. The Global Fund to Fight AIDS, Tuberculosis and Malaria has scaled back the number of funding-eligible nations it serves. Most recently, the White House proposed a 33% cut to the US foreign aid budget, jeopardizing more than US$6.7 billion currently earmarked for HIV/AIDS prevention, care, and research.
 
These developments raise important questions for donor and recipient nations alike: What are the likely health and economic effects of reduced global investment in HIV prevention and care? How much money can be saved while maintaining existing commitments? What cost-containment options are available, how much will each option save, and what harms will it create?
 
Working with colleagues in Côte d’Ivoire and the Republic of South Africa, we addressed these questions using a mathematical simulation and publicly available data. Here, we highlight four key findings:

The economic savings will be small and short-lived

Given existing commitments to persons already receiving care for HIV infection, savings greater than 30% of current outlays are unlikely. Moreover, most of the savings will dry up with time, as the downstream costs of patient neglect and failure to reduce HIV transmission accumulate.

The health harms will be large and lasting

Whether the yardstick is mortality, life-expectancy, or new HIV transmissions, cutbacks will almost certainly produce proportionally greater harm than economic good. We estimate more than 500,000 additional HIV transmissions and 1.6 million more HIV-related deaths in South Africa over the next 10 years. In Côte d’Ivoire, HIV-related deaths could increase 35% over that period.

For recipient nations, there are better and worse responses to reduced foreign assistance. 

Policies that either delay the presentation of the healthiest patients to care or reduce investments in patient retention will do the least harm in terms of deaths, years of life lost and new HIV transmissions.

Even if recipient nations act optimally to minimize the harm to their citizens, each year of life lost in Africa due to cutbacks will save donors no more than $900.

This fourth finding – and the shocking humanitarian cost it imposes on vulnerable populations – should take your breath away. Evidence abounds that citizens of resource-rich nations, like the United States and France, will willingly pay upwards of $100,000 to save a single year of life. Does the imposition of this disparity – a year of life to save ourselves $900 – accurately reflect how we in donor countries value life in Africa?
 
Scale-back of international aid to HIV programs in resource-limited settings will reverse enormous progress made over the past 20 years in curbing HIV transmission and improving HIV-related outcomes. We have it in our power – and even within our economic reach – to stop the global AIDS epidemic in its tracks. Now is the time to redouble our efforts, not to cut back and witness the reversal of hard-earned successes.


Related links

Lifting the barriers to female entrepreneurship

Lifting the barriers to female entrepreneurship

Whether setting up a new business, negotiating a pay rise or taking on more responsibility in the workplace, women can be supported in reaching leadership positions. As of 2018, Sciences Po's Women in Business Chair aims to improve understanding of the obstacles women face and spearhead action to remove them. Interview with Anne Boring, researcher in charge of the Chair. Anne’s work focuses on the analysis of gender inequalities in the professional world.

More
Meet Sciences Po's 2018 undergraduates

Meet Sciences Po's 2018 undergraduates

It’s the start of the academic year at Sciences Po, which means welcoming another cohort from across the globe to each of the seven undergraduate campuses. What do our students think of their new university? Why did they choose Sciences Po and what do they hope to achieve before the end of their studies? Hear their responses.

More
The Spy Who Studied at Sciences Po

The Spy Who Studied at Sciences Po

After graduating at the top of her class in July 1940, Jeannie de Clarens, née Rousseau, set out on an extraordinary career in the world of interpretation and espionage. At 23 years old, she was to hand Allied Forces one of the Second World War’s most precious pieces of intelligence. In memory of de Clarens, a true heroine of the French Resistance, Sciences Po now pays homage by giving her name to a lecture hall.

More
Lecture halls renamed after two legends

Lecture halls renamed after two legends

Students will now have class in the Simone Veil or Jeannie de Clarens lecture halls, the first at Sciences Po to be named after women. In honor of two extraordinary graduates, this decision to rename lecture halls after two female alumni with extraordinary stories is a symbolic gesture amongst other actions taken in favor of gender equality.

More
Sharyl Attkisson at the School of Journalism

Sharyl Attkisson at the School of Journalism

For the start of this academic year, the School of Journalism’s guest of honour was award-winning investigative journalist Sharyl Attkisson. Formerly an anchor for CNN and CBS News and now host of Full Measure, a US investigative news series, Attkisson has won multiple Emmy Awards and published two best-selling works of non-fiction, The Smear and Stonewalled. In her keynote speech to students, she discussed the state of journalism in a context of “fake news” and addressed the challenges facing anyone wishing to enter the “dynamic, troubled but important and exciting profession of journalism”.

More

"Cities in the Planetary Garden"

Known for his work fighting the Sicilian mafia as Mayor of Palermo in the 1980s and 90s, Leoluca Orlando now uses his position to advance the rights of migrants within Italy and elsewhere. He is currently negotiating to persuade the EU to allow freedom of movement for migrants. Follow his keynote speech,‘Cities in the Planetary Garden’, at the rentrée of the Sciences Po Urban School.

More