Alice Redfern, a Program Officer at GiveWell specializing in global health, discusses significant cuts to U.S. HIV/AIDS funding. She explores the impact of potential reductions on prevention programs targeting high-risk populations. The conversation highlights the need for innovative strategies to compensate for gaps in funding, especially for new treatments like lenacapavir. Redfern emphasizes the urgency of finding cost-effective opportunities to combat transmission and maintain stability in ongoing outreach initiatives.
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insights INSIGHT
Funding Cuts Open New HIV/AIDS Opportunities
GiveWell historically did not focus on HIV/AIDS due to substantial US government funding.
Current cuts of 20-50% may create new cost-effective funding opportunities in HIV/AIDS programs.
insights INSIGHT
Prevention Gaps in High-Risk Groups
Prevention for high-risk populations faces program cancellations while treatment and mother-to-child prevention remain funded.
Targeted prevention in these groups may yield the greatest impact on overall HIV transmission.
insights INSIGHT
Defining High-Risk HIV Populations
High-risk groups include sex workers, migrants, and adolescent girls and young women.
Targeting these groups efficiently is essential to maximize cost-effectiveness of HIV prevention.
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The US government has historically been a major funder of HIV/AIDS programs, providing around $5 to $6 billion annually through PEPFAR and other initiatives. With anticipated major reductions in US government foreign aid, including potential cuts of 20% to 50% to HIV/AIDS funding, GiveWell is assessing where new, cost-effective needs might emerge.
GiveWell aims to find programs where additional funding can have the greatest impact. While HIV/AIDS has not historically been a focus for GiveWell due to substantial US government support, the current funding cuts might lead to potential cost-effective opportunities within HIV/AIDS programming. In the latest episode in our podcast series, GiveWell CEO and co-founder Elie Hassenfeld speaks with Program Officer Alice Redfern about our initial exploration into HIV/AIDS programming.
Elie and Alice discuss:
Prevention programs for high-risk populations: While HIV/AIDS treatment and mother-to-child prevention programs are likely to retain funding, prevention programs targeting other high-risk groups have already seen significant cuts and program cancellations. GiveWell is focused on finding cost-effective opportunities within HIV/AIDS programming, and prevention efforts targeting high-transmission populations offer the greatest potential to reduce overall infection rates.
The challenge of finding cost-effective opportunities: Unlike GiveWell’s typical approach of broad coverage in a targeted geography (like distributing malaria nets to all children under five in high-burden areas), HIV prevention requires targeting high-risk populations to be cost-effective. This creates a complex “search problem” of identifying programs that efficiently reach these populations in areas with high transmission rates.
Promising innovations on the horizon: The emergence of highly effective, long-acting injectables like Lenacapavir offers game-changing potential for HIV prevention. However, their future cost-effectiveness and feasibility at scale depend on factors like price and real-world delivery challenges, including uptake and practical implementation.
This work is a good example of our ongoing efforts to identify where donor funding can be most impactful, which is especially important in the wake of recent cuts to US foreign assistance. We are working quickly to respond to emerging needs, leaning on partners and existing research to help us navigate the complexities and uncertainties of the HIV/AIDS funding landscape.
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