text: Abstract: An unprecedented surge in donor support for HIV/AIDS treatment over the last decade has lengthened and improved the lives of millions of people living with HIV/AIDS. But because the rate of new infections outpaces the rate of AIDS-related deaths, the number of people living with AIDS—and therefore the number of people needing treatment—is growing faster than the funding needed to treat them. In 2009, about 1.8 million people died from AIDS-related illnesses while about 2.6 million were newly infected with HIV, increasing the total number of people living with HIV/AIDS by more than three-quarters of a million.
  Abstract: More than a billion people suffer from neglected diseases, and millions die each year. Effective remedies have been few because of low investment, but with a surge in funding in the past decade, dozens of candidate drugs and vaccines are now in the pipeline. Before these products can reach the people who need them, they must be tested in large-scale clinical trials that are expensive, time-consuming, and risky. These trials must be conducted with highly vulnerable patients in resource-and infrastructure-poor countries where the neglected disease burden exists. There is not enough funding to support the costs and regulatory oversight of these clinical trials. A two-pronged approach to improve the quality and lower the cost of clinical trials in the developing world is needed.
  Abstract: Billions of dollars have been allocated to fight HIV/AIDS in poor countries over the past decade, yet less than half of those requiring treatment receive it, and for every two people put on treatment, five more become infected. This situation, in combination with the global economic crisis and the growing pressure to respond to broader global health objectives, is forcing donors to consider how to do more with their available funds. One way to improve the effectiveness of HIV/AIDS programs is to tie funding decisions to performance. Performance-based funding rewards effective programs and gives incentives for poor performers to improve. Donors have experimented with this approach, but they should do much more to ensure that funding decisions reflect and respond to how well funding recipients meet the objectives of their programs.
  Abstract: We are rapidly losing our ability to cure an alarming number of the most serious and common diseases of the developing world because of an invisible adversary: drug resistance. Resistance is inevitable—but careless practices in drug supply and use are hastening it unnecessarily. Without an immediate global effort to safeguard lasting treatment effectiveness, drug resistance will quickly become a widespread threat—claiming lives, raising the cost of curing patients, and making future generations increasingly vulnerable to deadly diseases that were easily cured in the past.
  Abstract: Few people doubt that gender inequality influences the spread of HIV/AIDS. Yet public health efforts tend to focus on changing individual behavior rather than addressing structural factors—social, economic, physical and political—that influence the spread and effects of HIV and AIDS.
  Abstract: Global health donors, like national governments, have traditionally paid for inputs such as doctors' salaries or medical equipment in the hope that they would lead to better health. Performance incentives offered to health workers, facility managers, or patients turn the equation on its head: they start with the performance targets and let those most directly affected decide how to achieve them. Funders pay (in money or in kind) when health providers or patients reach specified goals. Evidence shows that such incentives can work in a variety of settings. But making them effective requires careful planning, implementation, and monitoring and evaluation.