How We Lost the War Against AIDS

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16 Million Needless Deaths

President Trump’s proposed budget marks a dramatic and frightening turning point in the war against AIDS.  The budget includes a 20% cut in funding for PEPFAR, the very successful AIDS initiative launched by President George W. Bush in 2003.  A recent New York Times article indicated that the proposed cut would cost about a million lives.  That was a one-year estimate.  If we assume the cut is permanent, and that other countries follow the American lead, then we will ultimately lose the war against AIDS.  The effects will be catastrophic in human terms.  Up to 16 million people may die by the year 2030.

Those 16 million people don’t need to die.  The war against AIDS can still be won.  We have the medical tools.  We just need to use them.  That’s what the UNAIDS Fast Track strategy is all about.  If we follow the strategy, we can end AIDS as a public health threat by the year 2030.  The only question is whether the world has the collective will to do so.  A cut by the country that has historically been the moral and financial leader in the fight suggests that the world does not have the collective will to win the war.

The chart shows the number of AIDS-related deaths for two scenarios.  The blue line is taken from the most recent UNAIDS Fast Track update (April 2016).  The number of deaths gradually declines to about 340,000 per year in 2030.  The black line shows an adaptation of the UNAIDS model to reflect a 20% overall reduction in the global investment to fight AIDS.  The reduction has two primary effects:  the number of people receiving medication will go down; and prevention and testing initiatives will be less effective.  As a consequence, the number of deaths rises to about 1.9 million per year by 2030.  The total difference in deaths between the two lines from 2018 to 2030 is about 16 million people.

Perhaps these projections are overly pessimistic.  Perhaps other countries will not follow the American lead.  Perhaps the overall global reduction will be only 10%.  We still wouldn’t win the war against AIDS, but there would be only 13 million needless deaths.

Please pause for a minute to think about the use of the word “only” in the last sentence.  Should we really consider it to be good news that “only” 13 million people will needlessly die?  

This chart shows the “10% reduction” in the context of the history of the AIDS epidemic.  If there is “only” a 10% reduction in the global AIDS response, then the epidemic in the 2030s may be “only” a little better than it was in the worst days of the epidemic in the 1990s and 2000s.

I really, really hope that my projections are wrong.  But more than that, I hope that my model is irrelevant.  I hope that the United States will provide the moral and financial leadership that it has always provided in the fight against AIDS.  I hope that the United States, instead of hastening the path to defeat, will re-commit to winning the war against AIDS and to ending the AIDS epidemic by 2030.

NOTE:  If you are interested in the modeling methodology behind these projections, see my companion blog Projecting the Future of the AIDS Epidemic.