HIV/AIDS: Money Matters

Abstract

![Figure][1] CREDIT: KELLY KRAUSE/ SCIENCE Over the past decade, funding for HIV/AIDS research and treatment in low- and middle-income countries has exploded, jumping more than 20-fold to $10 billion last year. The U.S. National Institutes of Health (NIH), the largest funder of basic research, also doubled its budget to nearly $3 billion. In a 6-month investigation, Science correspondent Jon Cohen followed the money, looking at how these dollars have been divvied up and what they have accomplished (see overview, p. [512][2]), how countries have dealt with this sudden influx of cash (with a case study of Botswana, p. [526][3]), and who's minding the store and what happens when abuses occur (as in Uganda, p. [522][4]). He found that the billions of dollars the major funders have spent have been concentrated in a few countries—often for legitimate reasons—but not necessarily in the countries with the worst epidemics. And despite the massive influx of funds, the number of people in need of anti-HIV drugs continues to climb: a reflection of the treatment's success but also of the failure of prevention efforts. All of this raises unsettling questions about whether resources can keep up with future demands. A separate analysis looks at who has received the most NIH money and which authors and institutions have published the highest-impact papers (p. [518][5]). This issue appears on the eve of the XVII International AIDS Conference, which will run from 3 to 8 August 2008 in Mexico City. The conference motto is “Universal Action Now” (see the Editorial by Soto-Ramirez, p. [465][6]). Action requires funding. But as this package of stories emphasizes, money alone does not equal effective action. Strategic rethinking has to be a priority, as shown in two Perspectives. Grant et al. (p. [532][7]) discuss the ways in which poor choices and poor coordination have led to wasted efforts and recurrent crises in microbicide research. Fauci et al. (p. [530][8]) look at recent disappointments in HIV vaccine research and ways to reinvigorate the field. A Kaiser Family Foundation ( ) Media Fellowship helped support Jon Cohen's reporting for this project. Kaiser also maintains a useful Web site about HIV/AIDS funding ( ). More detailed information about this package of stories, including video documentaries, can be found on Science Online ([www.sciencemag.org/aids2008][9]). [1]: pending:yes [2]: /lookup/doi/10.1126/science.321.5888.512 [3]: /lookup/doi/10.1126/science.321.5888.526 [4]: /lookup/doi/10.1126/science.321.5888.522 [5]: /lookup/doi/10.1126/science.321.5888.520 [6]: /lookup/doi/10.1126/science.1162896 [7]: /lookup/doi/10.1126/science.1160355 [8]: /lookup/doi/10.1126/science.1161000 [9]: http://www.sciencemag.org/aids2008