U.N., U.S. Re-Evaluate HIV/AIDS Treatment Targets

Ahead of the U.N. High Level Meeting on AIDS, scheduled for June 8-10 in New York, "public-health leaders face a paradox: New evidence suggests the epidemic can finally be controlled, but that would demand increased spending at a time of severe global budget restraints," the Wall Street Journal reports. Preliminary estimates from the Kaiser Family Foundation and UNAIDS show last year donor funding for HIV/AIDS fell for the first time since the beginning of the epidemic, according to the newspaper.

The U.N. meeting will consider whether to set targets for how many people to put on treatment by 2015, but "such targets will not be met unless new money is found to buy medicine for more people after the 2010 funding drop," Wall Street Journal writes. Recently released results of an NIH-sponsored trial showing early antiretroviral therapy drastically reduces HIV transmission are complicating the issue, because when combined with other prevention strategies, many experts believe widespread HIV treatment "could turn the tide on an epidemic that currently infects more than 2.5 million people each year," the newspaper notes.

In the U.S., the Obama administration is in the midst of "a 'rigorous' internal dialogue to determine what targets and commitments would be needed to get enough people on treatment to reverse the epidemic, and what the U.S. contribution should be," according to U.S. Global AIDS Coordinator Ambassador Eric Goosby, Wall Street Journal reports. The U.S. goal currently is to treat four million people worldwide by 2013 (McKay/Schoofs, 5/27).

"We need to ask ourselves if this indeed presents an opportunity for us to be more effective in preventing new [HIV] infections," Goosby told journalists on Wednesday about the treatment as prevention research, NPR's health blog "Shots" reports. In addition to the cost, Goosby said ethical issues still exist about whether people living with HIV at any stage should have access to medications or if those with late-stage disease, pregnant women or children should be prioritized. "What I'm now committed to doing is shepherding the dialogue within the U.S. government – to go quickly, but I want to do it consciously," he said (Knox, 5/26).

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