Financing efficient HIV care and antiretroviral treatment to mitigate the impact of the AIDS epidemic on economic and human development

This text presents the second part of the book. In the first two decades of the HIV Epidemic, the strategy in developing world was focused on preventive methods. The challlenge is now give HIV treatment access for the benefit of People Living With HIV/Aids (PLWH) and for curbing the epidemic. Experiences in Brazil, Chile, Thailand are implemented to achieve this goal. In some African countries as Cote d'Ivoire, Senegal and Uganda, pilot projects have proved the feasibility and efficency of Antiretroviral treatments in subsaharian countries. These experiences show that a strong involvement of governments to promote or to regulate the delivery of ARV drugs is needed to face an eventual "antiretroviral anarchy". Scaling up access to ART will often take place in a context of failing government systems. The economic arguments against access to HIV treatment in developing countries are critically reviewed and the book brings evidence that treatment is rational as economic decision. Furthermore, the books stands the economic impact of the epidemic is underestimated with a new conceptual approach which highlights the "involution trap" where countries can fall in the long run. Some "optimistic" results of previous models, as a reduced pressure on land and capital, are artefacts. So the main rationale of HIV Treatment is to prevent falling in this trap : more resources must be allocated to scaling up programs. The book shows how countries can mobilize new resources. Every country must find the best balance between public subsidies, private insurance, private fundings and patients participation.