In this Huffington Post opinion piece, Nancy Birdsall, president of the Center for Global Development, reports on a World Bank- and USAID-sponsored debate she moderated last week as part of a series on HIV/AIDS issues, the topic of which was “Countries should spend a majority of what is likely to be a flat or even declining HIV prevention budget on ‘treatment as prevention.'” She notes several of her reactions to the debate and asks with regard to global health spending, “What about the pie? Even if it grows, there will be tradeoffs.”   

She concludes, “The debate about allocation of this (apparently fixed) HIV/AIDS pie between prevention and treatment … is newly raging because of new evidence from a randomized controlled trial: much earlier use of anti-AIDS drugs (‘treatment’) is in a biological sense hugely effective in preventing transmission of HIV-infected people to their partners. … Could this new exciting evidence mean the AIDS pie, which has stopped growing in the last couple of years, will now grow again?” (11/16).