Investments in HIV and AIDS are paying off by reducing incidence and mortality Carlos Avila, MD, ScD. Abt Associates, Washington DC Melbourne 22 July 2014

Abt Associates | pg 2 Haitian patient, before and after receiving free treatment for HIV and TB. Photographs by David Walton, Partners in Health. Kim J & Farmer P. NEJM 2006 March 2003 September 2003 People in the poorest places have access to life-prolonging medicines

Abt Associates | pg 3 There was a relative reduction of 96% in the number of linked HIV-1 transmissions Early antiretroviral therapy reduced sexual transmission and clinical events The results indicate both personal and public health benefits Clinical Trial HPTN 052

Abt Associates | pg 4 Problem Statement  The number of new infections and deaths have declined between 15-30%.  An estimated 14 million people are receiving life-saving anti-retroviral treatment (ART).  The world has experienced a widespread of preventive services.  Millions of orphans in poor countries have been provided with education and health care.  Evidence of the impact of HIV investments on health outcomes, based on empirical analysis, is almost non- existent

Abt Associates | pg 5 HIV investments are increasing while new HIV infections have fallen globally Annual HIV and AIDS investments New HIV infections Global,

Abt Associates | pg 6 Objective and Methods  Objectives: to examine the relationship between investments and HIV incidence as well as AIDS mortality.  Design: Panel data analysis including 63 low- and middle-income countries or 230 country-years data points from 2005 to  Data Sources: we used publicly available data including: HIV incidence, mortality, HDI, GDP and governance indicators from the World Bank.

Abt Associates | pg 7 Methods – II - Analysis  The common problems typical for panel data such as autocorrelation, stationary of time series and heteroscedasticity were examined carefully.  Fixed and Random Effect models were fitted to analyze association between HIV investments on incidence and mortality.  Dynamic panel specifications were explored and estimated by instrumental variables methods

Abt Associates | pg 8 Findings from panel data analysis Estimated effect of investments on AIDS-deaths Dependent VariableLog AIDS mortality per 1000 Fixed EffectsRandom Effects Lagged log AIDS expenditures per capita: β (se) (.024) (.019) ρ - value Number observations264 Number of countries63 Hausman test suggest that FE model is more appropriate.

Abt Associates | pg 9 Estimated effect of investments on HIV-incidence Dependent VariableLog HIV-Incidence rate per 1000 Fixed EffectsRandom Effects GMM* Lagged log HIV expenditures β (se) (.029) (.031) (.005) ρ – value <0.05 Number country/years *Using GNI as Instrumental Variable

Abt Associates | pg 10 Summary  International and domestic investments have a beneficial and statistically significant effect on AIDS mortality  Doubling per capita HIV/AIDS expenditures is associated with a 6% reduction in the AIDS mortality rate.  A 10% increase in HIV spending in the previous year is associated with reduction of 0.15% HIV incidence in the current year.  For the average country in Sub-Saharan Africa, increasing per capita HIV and AIDS investments by US$12 per year is associated with 250,000 fewer AIDS- related deaths or a 20% reduction.

Abt Associates | pg 11 Conclusions  Investments in HIV and AIDS are paying off by reducing new infections and mortality  The estimated effect is small, reflect past resource use and allocation and it is only marginal to other non- measured benefits  Looking forward, the resources needed should be lower, if future efficiencies and targeted responses replace wide investments made during the emergency phase of the global response

Thank you! Dejan Loncar M.Sc. MBA. The Global Fund, Geneva. Jaya Krishnakumar,PhD. Department of Economics, University of Geneva. Jose Antonio Izazola MD, ScD. UNAIDS, Geneva.