By Marie Rosenthal, MS
Failing to meet UNAIDS’s “95-95-95” HIV targets would entail tremendous human and economic consequences throughout the world, according to an analysis that will be presented at AIDS 2024, held in Munich (poster 11028).
The study, presented by Erik Lamontagne, PhD, a senior economist at UNAIDS, estimated the human and economic cost of failing to meet the “95-95-95” targets in 114 countries. These targets would be achieved when 95% of people who are living with HIV know their HIV status, 95% of people who know they are living with HIV are on antiretroviral therapy (ART) and 95% of people who are on ART are virally suppressed.
The study team compared the incremental costs, benefits and economic returns of a scenario that fulfills the targets to one that maintains coverage of HIV-related services at 2020 levels every year until 2050.
The human cost would include an estimated 34.9 million new HIV acquisitions and 17.7 AIDS-related deaths between 2021 and 2050. The economic cost would be an estimated $8,291 per person among all low- and middle-income countries by 2050, with an average cost of inaction per capita of $670.
“What do we mean by cost of inaction?” Dr. Lamontagne asked during a media briefing at AIDS 2024. “We mean the direct and the indirect cost of inaction when we fail to do the right thing.”
He cited scaling up ART, which could reduce HIV-related death and annual infections. “These are direct benefits, but it also enables those treated to live a normal life and contribute economically and socially [to society]. These are indirect benefits,” he explained.
To measure the cost of failing to take actions to meet the 95-95-95 goal, the economists compared the scenario of the HIV target with that of a counterfactual scenario where countries maintained the coverage rate of the different HIV activities at the level they were in 2020. The results were devastating in three areas, he said.
The first would be the economic costs mentioned above.
“Second, there’s also a human cost, and it’s perhaps the most poignant aspect of our study. Every life lost is a tragedy. Every new infection is a failure to protect the vulnerable. By 2050, the human cost of inaction could reach nearly 35 million more new infections and 17.7 million additional AIDS-related deaths,” he explained.
He added the third area included the social consequences of failing to end AIDS. “The forgone benefits we’re talking about here relate to gender inequality, health inequality, education inequality and economic inequalities.”
However, Dr. Lamontagne said investing in the 95-95-95 goal would provide hope for millions and could contribute to the economy of many countries. “It would also generate a net return on investment of $14.80 per capita for each dollar invested between now and 2050. So investing in people-centered prevention, universal access to treatment and ensuring equal right for all are within our reach, and this is the path to go,” Dr. Lamontagne said.
“The world is at a critical juncture in the response to HIV. This study reminds us just how much is at stake if we fail to act, and what can be achieved if we act now,” said Sharon Lewin, MD, PhD, the president of the International AIDS Society, AIDS 2024 International co-chair, and director of the Peter Doherty Institute for Infection and Immunity at the University of Melbourne, in Australia.
A new UNAIDS report released today shows the AIDS pandemic can be ended by 2030, but only if leaders boost resources and protect human rights now.
Although the end of AIDS is within the world’s grasp, this decade, the world is offtrack, according to a release by UNAIDS. Globally, of the 39.9 million people living with HIV, 9.3 million are not receiving lifesaving treatment. As a result, a person dies from AIDS-related causes every minute.
Leaders pledged to reduce annual new infections to below 370,000 by 2025, but new HIV infections are still more than three times higher than that—at 1.3 million in 2023. And now cuts in resourcing and a rising anti-rights push are endangering the progress that has been made.
“World leaders pledged to end the AIDS pandemic as a public health threat by 2030, and they can uphold their promise, but only if they ensure that the HIV response has the resources it needs and that the human rights of everyone are protected,” said UNAIDS Executive Director Winnie Byanyima, in a statement. “Leaders can save millions of lives, prevent millions of new HIV infections and ensure that everyone living with HIV can live healthy, full lives.”
