Introduction to special issue

HIV/AIDS: Money Matters

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Science  25 Jul 2008:
Vol. 321, Issue 5888, pp. 511
DOI: 10.1126/science.321.5888.511
CREDIT: KELLY KRAUSE/SCIENCE

Over the past decade, funding for HIV/AIDS research and treatment in low- and middle-income countries has exploded, jumping more than 20-fold to $10 billion last year. The U.S. National Institutes of Health (NIH), the largest funder of basic research, also doubled its budget to nearly $3 billion.

In a 6-month investigation, Science correspondent Jon Cohen followed the money, looking at how these dollars have been divvied up and what they have accomplished (see overview, p. 512), how countries have dealt with this sudden influx of cash (with a case study of Botswana, p. 526), and who's minding the store and what happens when abuses occur (as in Uganda, p. 522).

He found that the billions of dollars the major funders have spent have been concentrated in a few countries—often for legitimate reasons—but not necessarily in the countries with the worst epidemics. And despite the massive influx of funds, the number of people in need of anti-HIV drugs continues to climb: a reflection of the treatment's success but also of the failure of prevention efforts. All of this raises unsettling questions about whether resources can keep up with future demands.

A separate analysis looks at who has received the most NIH money and which authors and institutions have published the highest-impact papers (p. 518).

This issue appears on the eve of the XVII International AIDS Conference, which will run from 3 to 8 August 2008 in Mexico City. The conference motto is “Universal Action Now” (see the Editorial by Soto-Ramirez, p. 465). Action requires funding. But as this package of stories emphasizes, money alone does not equal effective action.

Strategic rethinking has to be a priority, as shown in two Perspectives. Grant et al. (p. 532) discuss the ways in which poor choices and poor coordination have led to wasted efforts and recurrent crises in microbicide research. Fauci et al. (p. 530) look at recent disappointments in HIV vaccine research and ways to reinvigorate the field.

A Kaiser Family Foundation (http://www.kff.org/) Media Fellowship helped support Jon Cohen's reporting for this project. Kaiser also maintains a useful Web site about HIV/AIDS funding (http://www.globalhealthfacts.org/). More detailed information about this package of stories, including video documentaries, can be found on Science Online (www.sciencemag.org/aids2008).

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