Those are just a few of the myriad decisions emerging from five days of conversation here at the 19th International AIDS conference that ended Friday.
For many of the 24,000 people here this week, the choice is clear.
“This is the first time the financing seems achievable,” said Diane V. Havlir, co-chair of the conference. “If we have an investment surge now, the costs will go down in as soon as 10 years.”
Former president Bill Clinton, whose charitable foundation has been a major force driving down the price of life-extending antiretroviral drugs, said maintaining momentum is the most important thing.
“Sometimes you have to make a commitment before you know how to get there,” he said during the closing ceremonies. “If we build it, they will come. If you scale it up and it works, the money will be there to fund it.”
The argument for spending more money, which is made at every conference, is especially good now. That’s because putting infected people on antiretroviral drugs essentially prevents them from infecting anyone else. That, in turn, avoids the expense of future AIDS cases (although the people kept uninfected and alive will want and need other health care).
In one presentation this week, UNAIDS epidemiologist Bernhard Schwartlander showed what would probably happen if global spending on AIDS grew to $24 billion a year — $7 billion more than is spent by rich and poor countries together now. New HIV infections, which number 2.7 million a year, would fall below 1 million a year by 2020.
“This does look like a really good investment to me,” he told the audience. “For me, the choice is clear. Let’s pay now, and not forever.”
Another urgent priority, many said this week, is preventing mother-to-child transmission of HIV.
Such infections are almost unheard of in the United States because pregnant women are prescribed antiretroviral drugs during pregnancy. The District of Columbia hasn’t had one since 2009. Worldwide, however, 330,000 babies were born infected last year.
Slightly more than half of infected pregnant women in low- and middle-income countries get HIV-prevention drugs to prevent transmission. Many of them, however, are taken off the medicines when they stop breast feeding, because their infection is in an early stage and they don’t meet the criteria for treatment under World Health Organization guidelines.