HIV/AIDS: The Big Picture

For the first time, there is real promise that we can turn the tide against HIV/AIDS. Recently, treatment has been shown as one of the best possible ways for dramatically reducing transmission of the disease. Yet also for the first time in the history of the AIDS epidemic, the resources available for treating HIV in low and middle income countries have flat lined, largely due to the global financial crisis. The biggest challenge the HIV community is facing is the economic challenge. As two thirds of people who require treatment are still not receiving it, CHAI is helping governments find ways of economizing their treatment programs in order to take advantage of the new, exciting opportunities to reverse the course of the epidemic.


While more resources are needed to fight HIV/AIDS, we can also do more with the money we have. CHAI believes that the fight against HIV/AIDS requires not only the funds of governments and donors, but also the brains of those who can identify better ways of economizing while still improving quality of care. Accordingly, CHAI is working to help governments and donor agencies get the most out of money that is invested in treating HIV/AIDS. CHAI approaches this in three main ways. First, by changing the economics of care and treatment. Second, by helping governments accelerate large scale up of critical treatment programs. And third, by helping to drive uptake of key products such as medicines and diagnostic tools. CHAI has played a significant role is driving treatment scale-up, achieving the following over the past decade:

  • 3.9 million people – representing more than 60% of people being treated for HIV/AIDS globally – have access to reduced-priced medicines negotiated by CHAI.
  • When CHAI began leading global efforts in 2005 to treat children with HIV/AIDS, only one in forty children in need of treatment received it. Today, the number is roughly one in three, with more than 350,000 children receiving treatment in countries where CHAI helped with the UNITAID donation. In 2004, a course of pediatric ARVs cost $567 per year. By 2006, CHAI negotiated price reductions to lower the cost to $60 per year.
  • When CHAI first began putting children on treatment, caregivers had to administer three syrups twice a day, every day – forcing them to make the trip to a health clinic once a month to pick up a dozen or more bottles for a single child. Thanks to CHAI’s work with the pharmaceutical industry, today pediatric treatment comes in the form of a once-daily, three-in-one tablet, with a month’s supply fitting in the palm of one’s hand.
  • In some countries, only 33% of people who test positive for HIV are ultimately enrolled in treatment. CHAI is helping to popularize a portable machine that can be used anywhere to immediately tell someone what their CD4 count is. This “point of care” testing is cutting in half the time between testing and ART initiation.


Exciting new advances in the fight against HIV/AIDS are emerging. New findings show that putting HIV-positive people on treatment while they are healthy can also curb transmission to non-infected sexual partners by 96%. CHAI will be putting this “treatment as prevention” strategy into action for more than 90% of people in Swaziland, the country with the world’s highest HIV prevalence rate at 26%. Treatment is also the primary intervention to prevent maternal to child transmission (PMTCT) of HIV, with upward of 80% of infections being averted by having women who are eligible receive the treatment. Going forward, CHAI will assist a broader set of governments to effectively plan and manage the scale-up of their PMTCT programs. CHAI will also increase survival rates in many countries by helping governments initiate earlier treatment, making greater use of new microbicides as they come to market and are proven effective, and using new tools to increase testing for tuberculosis and other opportunistic diseases among people living with HIV. While all of these new interventions hold great promise, there is often a lag between scientific proof of efficacy and full uptake of new technologies and services. CHAI will continue focusing on key activities required at each step along a product’s or service’s path to market in order to drive widespread uptake.