Economic Returns to Investment in AIDS Treatment in Low and Middle Income Countries

Since the early 2000s, aid organizations and developing country governments have invested heavily in AIDS treatment. By 2010, more than five million people began receiving antiretroviral therapy (ART) – yet each year, 2.7 million people are becoming newly infected and another two million are dying without ever having received treatment. As the need for treatment grows without commensurate increase in the amount of available resources, it is critical to assess the health and economic gains being realized from increasingly large investments in ART. This study estimates total program costs and compares them with selected economic benefits of ART, for the current cohort of patients whose treatment is cofinanced by the Global Fund to Fight AIDS, Tuberculosis and Malaria. At end 2011, 3.5 million patients in low and middle income countries will be receiving ART through treatment programs cofinanced by the Global Fund. Using 2009 ART prices and program costs, we estimate that the discounted resource needs required for maintaining this cohort are $14.2 billion for the period 2011–2020. This investment is expected to save 18.5 million life-years and return$12 to $34 billion through increased labor productivity, averted orphan care, and deferred medical treatment for opportunistic infections and end-of-life care. Under alternative assumptions regarding the labor productivity effects of HIV infection, AIDS disease, and ART, the monetary benefits range from 81 percent to 287 percent of program costs over the same period. These results suggest that, in addition to the large health gains generated, the economic benefits of treatment will substantially offset, and likely exceed, program costs within 10 years of investment

Unravelling Stakeholder Perceptions to Enable Adaptive Water Governance in Dryland Systems

Adaptive water governance seeks to increase a social-ecological system’s adaptive capacity in the face of uncertainty and change. This is especially important in non-linear dryland systems that are already exposed to water scarcity and increasing degradation. Conservation of water ecosystem services is key for increasing adaptive capacity in drylands, however, how stakeholders perceive water ecosystem services greatly affects how they are managed, as well as the potential for adaptive water governance. This paper focuses on identifying the system’s potential for enabling adaptive water governance by analysing different stakeholder perceptions on water ecosystem services. It takes the Rio del Carmen watershed as a case study, offering important insights for an increasing number of water-scarce regions. Semi-structured interviews were conducted with key stakeholders in the watershed in order to unravel their perceptions and understand the governance context. We found disparities in how stakeholders perceive water ecosystem services have led to water overexploitation and several conflicts over water access. Our results indicate that stakeholder perceptions have a major influence on the system’s adaptability, as they shape the acquisition of water ecosystem services. Divergent stakeholder perceptions act as an important barrier to collaboration. Generating and sharing knowledge could facilitate the development of a common vision, allowing all actors to co-create information about water ecosystem services and the system state, engaging them in a participatory process, suitable for their context, and that will better support adaptive water governance