Focusing more treatment on women in Africa, drug users in places where needles drive the epidemic and on gay and bisexual men where that is appropriate can go a long way to fighting the virus, Gates told reporters.
“We can focus our prevention efforts. We can look at where there is the most impact,” Gates said.
Gates, whose Bill & Melinda Gates Foundation spends a large chunk of its $34 billion endowment on fighting AIDS, is influential in directing other spending as well. He has pushed governments, non-profit groups and other philanthropies to join efforts he supports.
One big goal is to extend treatment to more people. An estimated 33.4 million people worldwide are infected with the human immunodeficiency virus that causes AIDS. Only about five million people get drugs that can keep patients healthy and reduce the risk they will infect someone else.
“With treatment, the challenge is the financing,” Gates told reporters in a preview of a keynote speech next Tuesday at the International AIDS Society conference in Vienna. The conference is a gathering of AIDS researchers, activists, patients and advocates held every two years.
“We want to broaden treatment. The only way to do that is efficiency,” Gates said, noting that no one has the money to treat everyone who needs it.
“Clearly we are facing a major challenge in terms of funding because the global economic downturn has a lot of governments looking hard at their budgets,” he said.
He noted that intense pressure had persuaded drug makers such as GlaxoSmithKline to provide inexpensive drugs to poor countries and to allow generic pharmaceutical companies to make cheap copies in countries such as India.
“Now we need to look at delivery costs, personnel costs and administration costs,” Gates said.
“It is clear from some countries where treatment costs are quite low that if we take best practices and spread those around, we can really do a lot better there.”
While treatment saves lives and prevents new infections, it is not the only way to prevent the spread of the disease, Gates said. “Other prevention efforts continue to be very important, like male circumcision, like pushing for behavior change, including condom use.”
Gates has also pressed for development of a microbicide — a gel, cream or device that women, and perhaps men, can insert to protect themselves from sexual transmission of the virus.