When the global AIDS pandemic hits its 50th year, annual spending needed to fight the disease in developing countries could reach $35 billion, three times the current level, according to a new study. At the same time, more than 1 million people could be newly infected each year, estimates researchers for the AIDS 2031 project. The study is one of a series of articles about HIV in the November/December issue of Health Affairs.

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"The cost of fighting the epidemic for treatment and prevention is rising very rapidly around the world, especially in southeastern Africa," says study coauthor Robert Hecht, managing director of the Washington-based Results for Development Institute. In the current global financial crunch, funding resources are becoming scarcer and other priorities more competitive, he says.

This is "a moment of opportunity because it's a chance for government officials and external funders to take a hard look at what they have been doing and to find ways to spend the money that is available in a more efficient way to cut down on waste," Hecht says. Economizing strategies "need to be addressed as soon as possible if we are going to see a successful fight against AIDS over the next 10 to 20 years," he says.

One example of shifting to high-impact strategies would be to rely on nurses rather than doctors for treatment in some cases, said Hecht. For high-impact prevention, male circumcision has been shown to be very effective in reducing female-to-male HIV risk. Most young adult males are not circumcised in southeastern Africa, and infection rates there remain high, he said. In addition, antiretroviral drugs very effectively reduce mother-to-child HIV transmission risk, he noted.