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The economic returns of achieving the 2021-2030 AIDS targets to end the AIDS epidemic by 2030

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BACKGROUND: In 2019, several countries have achieved or were on track to end AIDS. Despite progress towards that goal, AIDS remains a global crisis. The gains achieved are still fragile in many countries. In June 2021, the General Assembly of the United Nations adopted the Political Declaration on HIV and AIDS: Ending Inequalities and Getting on Track to End AIDS by 2030. We estimated the benefits and costs of this ambitious commitment.
METHODS: We estimated the incremental costs benefits and economic returns of a scenario which fulfils the AIDS targets stated in the Political Declaration, compared to a counterfactual scenario defined as maintaining coverage of HIV-related services at 2020 levels. The benefits are calculated using the full-income approach, which values both the change in income and in mortality. We value both the health gain and the intervention cost to each HIV-affected country from the perspective of that country, converting national benefits and costs to purchasing-parity-equivalent (PPP) 2019 US dollars. We estimated the value of the projected reduction in the mortality rate of the HIV programmes as the amount an average person would pay to reduce their risk of death by one in 10,000 for one year. From the literature, this amount varies between 1.0 and 1.6% of GDP per capita. We allowed the income-elasticity of the willingness to pay for mortality risk reduction to decline at either 1% or 1.5% for every percentage decline of the country's income.
RESULTS: Using the full-income approach, we found that each additional dollar invested between 2021 and 2030 generates US$ 7.37 [4.52-11.79] in economic returns. Returns on investment vary substantially between countries, regions, and income categories. Returns are higher in countries with higher purchasing power as measured by their GDP per capita. The benefits of investment are also highly correlated with the total number of adults living with HIV.
CONCLUSIONS: Using the latest scientific evidence in terms of benefit-cost analysis, it appears that investing to achieve the 2025 targets in the UNAIDS Strategy and the 2030 target in the Agenda for Sustainable Development provides significant returns from both human and economic perspectives.