HIV Spending as a Share of Total Health Expenditure: An Analysis of Regional Variation in a Multi-Country Study

Background: HIV has devastated numerous countries in sub-Saharan Africa and is a dominant health force in many other parts of the world. Its undeniable importance is reflected in the establishment of Millennium Development Goal No. 6. Unprecedented amounts of funding have been committed and disbursed over the past two decades. Many have argued that this enormous influx of funding has been detrimental to building stronger health systems in recipient countries. This paper examines the funding share for HIV measured against the total funding for health. Methodology/Principal Findings: A descriptive analysis of HIV and health expenditures in 2007 from 65 countries was conducted. Comparable data from individual countries was used by applying a consistent definition for HIV expenditures and total health expenditures from NHAs to align them with National AIDS Assessment Reports. In 2007, the total public and international expenditure in LMICs for HIV was 1.6 percent of the total spending on health, while the share in SSA was 19.4 percent. HIV prevalence was six-fold higher in SSA than the next highest region and it is the only region whose share of HIV spending exceeded the burden of HIV DALYs. Conclusions/Significance: The share of HIV spending across the 65 countries was quite moderate considering that the estimated share of deaths attributable to HIV stood at 3.8 percent and DALYs at 4.4 percent. Several high spending countries are using a large share of their total health spending for HIV health, but these countries are the exception rathe

Levels of Spending and Resource Allocation to HIV Programs and Services in Latin America and the Caribbean

BACKGROUND: An estimated 1.86 million people are living with HIV in Latin America and the Caribbean (LAC). The region is comprised of mainly middle-income countries with steady economic growth while simultaneously there are enormous social inequalities and several concentrated AIDS epidemics. This paper describes HIV spending patterns in LAC countries including analysis of the levels and patterns of domestic HIV spending from both public and international sources. METHODS AND FINDINGS: We conducted an extensive analysis of the most recently available data from LAC countries using the National AIDS Spending Assessment tool. The LAC countries spent a total of US$ 1.59 billion on HIV programs and services during the latest reported year. Countries providing detailed information on spending showed that high percentages are allocated to treatment and care (75.1%) and prevention (15.0%). Domestic sources accounted for 93.6 percent of overall spending and 79 percent of domestic funds were directed to treatment and care. International funds represented 5.4 percent of total HIV funding in the region, but they supplied the majority of the effort to reach most-at-risk-populations (MARPs). However, prevalence rates among men who have sex with men (MSM) still reached over 25 percent in some countries. CONCLUSIONS: Although countries in the region have increasingly sustained their response from domestic sources, still there are future challenges: 1) The growing number of new HIV infections and more people-living-with-HIV (PLWH) eligible to receive antiretroviral treatment (ART); 2) Increasing ART coverage along with high prices of antiretroviral drugs; and 3) The funding for prevention activities among MARPs rely almost exclusively on external donors. These threats call for strengthened actions by civil society and governments to protect and advance gains against HIV in LAC

Thermodynamic anomalies in open quantum systems: Strong coupling effects in the isotropic XY model

The exactly solvable model of a one dimensional isotropic XY spin chain is employed to study the thermodynamics of open systems. For this purpose the chain is subdivided into two parts, one part is considered as the system while the rest as the environment or bath. The equilibrium properties of the system display several anomalous aspects such as negative entropies, negative specific heat, negative susceptibilities in dependence of temperature and coupling strength between system and bath. The statistical mechanics of this system is studied in terms of a reduced density matrix. At zero temperature and for a certain parameter values we observe a change of the ground state, a situation akin to a quantum phase transition.Comment: 12 pages, 8 figures. Published in the special issue of Chemical Physics "Stochastic processes in Physics and Chemistry" (in honor of Peter H\"anggi

Financing essential HIV services: a new economic agenda.

Anna Vassall and colleagues discuss the need for, and challenges facing, innovative and sustainable financing of the HIV response. Please see later in the article for the Editors' Summary

Sparse Aperture Masking (SAM) at NAOS/CONICA on the VLT

The new operational mode of aperture masking interferometry has been added to the CONICA camera which lies downstream of the Adaptive Optics (AO) corrected focus provided by NAOS on the VLT-UT4 telescope. Masking has been shown to deliver superior PSF calibration, rejection of atmospheric noise and robust recovery of phase information through the use of closure phases. Over the resolution range from about half to several resolution elements, masking interferometry is presently unsurpassed in delivering high fidelity imaging and direct detection of faint companions. Here we present results from commissioning data using this powerful new operational mode, and discuss the utility for masking in a variety of scientific contexts. Of particular interest is the combination of the CONICA polarimetry capabilities together with SAM mode operation, which has revealed structures never seen before in the immediate circumstellar environments of dusty evolved stars.Comment: 11 pages, 10 figures, SPIE 201

A Controlled Study of Funding for Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome as Resource Capacity Building in the Health System in Rwanda

Because human inmmunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) receives more donor funding globally than that for all other diseases combined, some critics allege this support undermines general health care. This empirical study evaluates the impact of HIV/AIDS funding on the primary health care system in Rwanda. Using a quasi-experimental design, we randomly selected 25 rural health centers (HCs) that started comprehensive HIV/AIDS services from 2002 through 2006 as the intervention group. Matched HCs with no HIV/AIDS services formed the control group. The analysis compared growth in inputs and services between intervention and control HCs with a difference-in-difference analysis in a random-effects model. Intervention HCs performed better than control HCs in most services (seven of nine), although only one of these improvements (Bacille Calmette-Guérin vaccination) reached or approached statistical significance. In conclusion, this six-year controlled study found no adverse effects of the expansion of HIV/AIDS services on non-HIV services among rural health centers in Rwanda

Measuring multipartite entanglement via dynamic susceptibilities

Entanglement plays a central role in our understanding of quantum many body physics, and is fundamental in characterising quantum phases and quantum phase transitions. Developing protocols to detect and quantify entanglement of many-particle quantum states is thus a key challenge for present experiments. Here, we show that the quantum Fisher information, representing a witness for genuinely multipartite entanglement, becomes measurable for thermal ensembles via the dynamic susceptibility, i.e., with resources readily available in present cold atomic gas and condensed-matter experiments. This moreover establishes a fundamental connection between multipartite entanglement and many-body correlations contained in response functions, with profound implications close to quantum phase transitions. There, the quantum Fisher information becomes universal, allowing us to identify strongly entangled phase transitions with a divergent multipartiteness of entanglement. We illustrate our framework using paradigmatic quantum Ising models, and point out potential signatures in optical-lattice experiments.Comment: 5+5 pages, 3+2 figure

Daily and Nondaily Oral Preexposure Prophylaxis in Men and Transgender Women Who Have Sex With Men: The Human Immunodeficiency Virus Prevention Trials Network 067/ADAPT Study

Background: Nondaily dosing of oral preexposure prophylaxis (PrEP) may provide equivalent coverage of sex events compared with daily dosing. Methods: At-risk men and transgender women who have sex with men were randomly assigned to 1 of 3 dosing regimens: 1 tablet daily, 1 tablet twice weekly with a postsex dose (time-driven), or 1 tablet before and after sex (event-driven), and were followed for coverage of sex events with pre- and postsex dosing measured by weekly self-report, drug concentrations, and electronic drug monitoring. Results: From July 2012 to May 2014, 357 participants were randomized. In Bangkok, the coverage of sex events was 85% for the daily arm compared with 84% for the time-driven arm (P = .79) and 74% for the event-driven arm (P = .02). In Harlem, coverage was 66%, 47% (P = .01), and 52% (P = .01) for these groups. In Bangkok, PrEP medication concentrations in blood were consistent with use of ≥2 tablets per week in >95% of visits when sex was reported in the prior week, while in Harlem, such medication concentrations occurred in 48.5% in the daily arm, 30.9% in the time-driven arm, and 16.7% in the event-driven arm (P < .0001). Creatinine elevations were more common in the daily arm (P = .050), although they were not dose limiting. Conclusions: Daily dosing recommendations increased coverage and protective drug concentrations in the Harlem cohort, while daily and nondaily regimens led to comparably favorable outcomes in Bangkok, where participants had higher levels of education and employment