San Francisco Chronicle - Wednesday, September 26, 2007
Sabin Russell, Chronicle Staff Writer, srussell@sfchronicle.com

It would take a quadrupling of current spending, to $42 billion a year, to treat all 14 million people who will need the drugs just three years from now, according to UNAIDS, the Joint United Nations Program on HIV/AIDS.

That's an unlikely outcome in a climate where the pace of international giving for AIDS treatments is showing signs of slackening.

On Tuesday, British Prime Minister Gordon Brown announced a plan to spend $2 billion over the next eight years on international AIDS assistance. It was a big boost in spending, but British AIDS activists had been expecting about $1.4 billion in just three years.

"It's a real disappointment," said Alvaro Bermejo, executive director of the International HIV/AIDS Alliance in Brighton, England.

Similarly, President Bush's pledge to double international AIDS spending to $30 billion from 2009 to 2013 disappointed some American AIDS activists, who noted the plan increased average annual spending by only $600 million in each of those five years.

Although these numbers are stratospheric compared to spending on AIDS in the 1990's, the new UNAIDS report makes clear that the vital goal of expanding HIV prevention efforts and bringing antiviral drugs to all who need them is a very costly proposition.

"We are simply not spending enough, or doing enough," said Dr. Michel Sidibe, deputy executive director of UNAIDS, during a telephone news conference Tuesday.

The bulk of spending would be directed to sub-Saharan Africa, where 60 percent of the 26 million people living with HIV infection reside.

The UNAIDS analysis showed that if spending continues on its current modest growth path, the world will not come close to meeting the universal access goal that had been endorsed by the major industrial powers at the G-8 Summit in Gleneagles, Scotland, two years ago.

On its current trajectory, global spending on AIDS would increase to $15.4 billion in 2010, and would bring AIDS treatments to 4.6 million people. But that is only about one-third of the people who will need them - leaving out more than 9 million who might expect to live three years or less with their disease.

In that light, the Geneva agency provided a fallback plan, a scaled-down blueprint for rolling out prevention programs and enough AIDS drugs to treat 8 million people by 2010. It would postpone the goal of universal access until 2015 and cost about one-third less than the $42 billion that would be required to meet the goal by 2010.

"Even this secondary goal is very ambitious," said Dr. Paul De Lay, policy director for UNAIDS, during the phone conference.

The alternative plan would still require a near tripling of today's global AIDS spending - from $10 billion to $28.4 billion a year by 2010. When universal access is achieved in 2015, the annual cost would be $50 billion.

These various spending scenarios were released on the eve of meetings to take place in Berlin this week among donor nations considering additional funding requests by the Global Fund to Fight AIDS, Tuberculosis and Malaria. Global Fund officials are hoping for additional pledges of up to $8 billion through 2010.

Dr. Richard Feachem, the former executive director of the Global Fund who has just returned to his faculty post at UC San Francisco, said it would be a "huge leap" to meet the $42 billion spending requirement of universal access by 2010.

The alternative strategy, Feachem said, recognizes that many countries in need of AIDS services simply do not have the medical infrastructure to handle a large influx of assistance.

"The fallback scenario falls short of universal access, but it would still be an enormous achievement."

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