The Policy Brief argues that the moral duty to provide life-long treatment to people diagnosed with HIV, while saving millions of productive lives, creates an enduring liability that is like a debt. This burden is significant for African countries with generalised epidemics. And it has far-reaching implications, requiring a rethink of the way we finance the HIV response and prioritise interventions.
Recognise the threat to fiscal sustainability posed by long-term HIV liabilities
Incorporate this liability in national financial projections and into aid planning
Minimise the total fiscal liability through more attention to cost-effective measures of prevention
Spending on prevention should be pursued up to the point at which the marginal dollar spent on prevention reduces the discounted liability of treatment by at least one dollar
For national policy-makers: What are the implications of acknowledging the long-term liability posed by HIV treatment for your country? Which synergies and efficiencies can be harnesssed to reduce them? Where can new fiscal space be found to finance the response domestically?
For donors: How will you factor these long term liabilities into your planning? What opportunities are there to rethink the financing architecture of the response?
For all policy-makers: Which prevention methods could help reduce HIV fiscal liabilities? Which blue sky investments are required to change the course of the pandemic? What new commitment technologies should be put in place by donors and affected governments for the long-term effective, responsible financing of the HIV response?
RethinkHIV is a consortium of senior researchers from London School of Hygiene & Tropical Medicine, Imperial College London, Harvard School of Public Health, Centre for the Study of African Economies and Blavatnik School of Government at Oxford University.
The consortium will evaluate new evidence related to the costs, benefits, effects, fiscal implications, and developmental impacts of HIV interventions in sub-Saharan Africa, in order to maximise contributions to the fight against HIV there.
The aim of RethinkHIV is to find ways of creating, optimising, and sustaining fiscal space for domestic HIV investment, as well as exploring long-term, sustainable national and international financing mechanisms. RethinkHIV is funded by RUSH Foundation.