Money Changes Everything

Bjorn Lomborg, a Danish activist, writer, and researcher, wants governments and health experts to think big when it comes to HIV'real big. Lomborg's think tank, the Copenhagen Consensus Center, recently launched an ambitious project, RethinkHIV, to explore how AIDS money is spent in sub-Saharan Africa, where 70% of all HIV-positive people live and where over 80% of all AIDS deaths occur. Experts looked at whether the billions of dollars being spent there can be better utilized'many suggested shifting dollars from short-term efforts like hiring more health workers toward long-term strategies like vaccine research. 'A billion dollars spent on one set of approaches can't be spent elsewhere,' Lomborg told Slate last year. That central question was the basis for RethinkHIV: where should money go? 'So where is it best to spend more first? Often, this simple question is not asked, because doing so means choosing between many popular strategies, each with its own base of enthusiastic supporters.' The Copenhagen Consensus Center teamed with the HIV think-tank the Rush Foundation, to create RethinkHIV, with the hopes of starting a dialogue that could lead to policy changes in Africa, and possibly around the world. RethinkHIV gathered some of the world's top economists, population experts, and public health authorities and asked them to write 18 research papers on HIV spending in hard-hit sub-Saharan Africa. They specifically wanted those leaders to talk about how a relatively small increase in funds ($10 billion over the next five years) could best be used. The research covered six major areas'health systems, social policy, treatment, vaccine research, sexual transmission, and non-sexual transmission'three individuals spoke to each different topic, so a diversity of opinions was shared. Those RethinkHIV papers were then discussed in three panel discussions last fall at Washington, D.C.'s Georgetown University. Using the RethinkHIV reports as background, participants that included students, health experts, and leaders at HIV organizations ranked their spending priorities. Organizers found that there were more similarities than differences. Near or at the top of all lists was providing male circumcision services and preventing mother-to-child transmission by putting money toward top-notch treatment of HIV-positive pregnant women. Economist Lori Bollinger believes mother-to-child transmissions in sub-Saharan Africa could practically be wiped out by 2015 with additional expenditures of only $140 million a year. While efforts like abstinence programs were seen as a bad investment, there was strong support for making blood transfusions safer, as well as increased vaccine studies. Researchers Dean Jamison and Robert Hecht believe at current funding levels a vaccine could happen in two decades. Adding $100 million a year to spending could significantly shorten that timetable. 'We see RethinkHIV as opening a new dialogue and discussion among researchers, donors, governments, and civil society,' Lomborg tells HIV Plus. 'In coming months and years, we expect to see this significant first effort responded to and built upon by researchers from many fields.' RethinkHIV suggestions will be brought to more organizations and universities as a way to continue the discussion. Rethink-related panels, many focusing on youth issues, were organized at November's International Conference on AIDS and STIs in Africa in Addis Ababa, Ethiopia. But what about America? While needs here are not as dire as in Africa, HIV rates are on the rise among gay men, while treatment funds remain scarce, as evident with the struggling AIDS Drug Assistance Program. The RethinkHIV papers are only applicable to Africa, Lomborg says, but the methods in which they were assembled could be used for a similar American study. 'The framework itself [of RethinkHIV]'of utilizing cost-benefit analysis to find out which actions are most valuable to society compared to their societal costs'could be applied to an American context,' he says.