In DepthInfectious Disease

Obstacles loom along path to the end of AIDS

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Science  29 Jul 2016:
Vol. 353, Issue 6298, pp. 432-433
DOI: 10.1126/science.353.6298.432

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At the International AIDS Conference held in Durban, South Africa, last week sobering realities confronted the push to end the AIDS epidemic by 2030, a goal set by the Joint United Nations Programme on HIV/AIDS (UNAIDS). One huge obstacle is funding. There currently are 17 million people receiving antiretroviral (ARV) drugs, but nearly 20 million others are not. The two big organizations that bankroll most treatment around the world both have serious financial constraints. The U.S. governmental bilateral program the President's Emergency Plan for AIDS Relief has had a flat budget since 2009. The Global Fund to Fight Aids, Tuberculosis and Malaria, the other big player, is in the midst of a "replenishment drive" that is asking wealthy countries to donate $13 billion at a moment when the United States and many European countries are facing political uncertainty. The generic drug companies that supply the ARVs to three-fourths of the people in low- and middle-income countries say they also need a more stable marketplace to scale up to what amounts to double the production they're doing today. They also say they're being pressured to sell first-line treatment for less than $100 per person per year, which is not feasible given their slim profit margins. On top of these challenges, global new infection rates have not dropped even with the massive roll out of treatment, and Eastern Europe and central Asia have seen an increase of 57% in new infections between 2010 and 2015. At the meeting's opening ceremony, UNAIDS Director Michel Sidibé summed up the widespread sentiment at the huge gathering. "I'm scared," Sidibé said.