According to HIV Vaccines and Microbicides: Resource Tracking Working Group, in 2013 the reported funding for HIV prevention R&D declined by $50 million (4%) compared to 2012, after moderate increases during the past five years in most HIV prevention R&D research areas, resulting in a total of $1.26 billion.
The 2013 decrease can be attributed largely to diminished U.S. investment in all areas of HIV prevention research, as well as significantly reduced investment in some European countries. Changes in the international development landscape and the evolution of the HIV prevention research pipeline also played a role.
As the largest funder of HIV prevention R&D, the commitment of the U.S. public sector has largely driven global HIV R&D and has shaped trends over the past decade. In the past five years, the U.S. public sector has funded 70% of the total global investment in HIV prevention R&D, and in 2013 this percentage remained at 70%, at $887 million. However, between 2012 and 2013, U.S. public-sector funding declined nearly $38 million (4%), down from $925 million in 2012.
European and other public-sector funding also fell in 2013. Investment by public-sector agencies in Europe declined 10%, from $86 million in 2012 to $77 million in 2013. Funding sources across the continent—including Belgium, Germany, the Netherlands, Spain, Sweden, Switzerland and the U.K.—decreased their support in 2013. Public-sector funding outside of Europe also declined by 6%, from $69 million in 2012 to $65 million in 2013.
Investment has declined for HIV prevention options that have proven effective (i.e., voluntary medical adult male circumcision and female condoms), as investments go increasingly toward implementation of these tools. Conversely, investment has increased in support of treatment as prevention (TasP) and pre-exposure prophylaxis (PrEP), advancing these into successful implementation phases.
Funding for HIV prevention options that are more upstream, such as vaccines and microbicides, is going toward the revitalization of a pipeline that has seen several large trials close out in the last few years. Investment has in part reflected this movement and the nature of funding clinical trials; the discontinuation of immunizations in the HIV Vaccine Trials Network’s HVTN 505 trial, the most recent ongoing AIDS vaccine efficacy trial and the completion of the Microbicide Trial Network’s VOICE study played a role in the decline of investments in 2013.
Prevention research still does not reflect the widespread consensus that the epidemic cannot be ended without focusing on disproportionately affected populations. Only six percent of trial participants in 2013 belonged to one of these populations. At the same time, these populations account for much higher proportions of new infections in priority research countries like Kenya and Nigeria.
Of particular concern is a recent push to pass anti-homosexuality laws in at least 11 countries in sub-Saharan Africa. Homosexuality already is illegal in those countries, where 73% of 2013 research projects took place. If this trend continues, the research community will find it increasingly difficult to answer critical questions about how the prevention needs of affected populations can be met.
Another major impediment to research on prevention options in these populations is the widespread disrespect for girls’ and women’s rights, resulting in challenges including violence against women, as well as criminalization of homosexuality, and the marginalization of injecting drug users and commercial sex workers.
Gender-based violence, restricted access to education and secure income and limited ability to make decisions about sexual and reproductive lives are the context in which any HIV prevention trials take place. All of these factors affect the ability of women to participate in HIV prevention trials, to continue participation once involved in trials, to use products and to actively engage in the research process. The factors that affect women’s participation in research are some of the very reasons it is vital that HIV prevention research for women continue.
HIV/AIDS is the leading cause of death for women in their reproductive years, and for young women the HIV prevalence rate is twice that of young men.