HIV Prevention Research in a Time of Scarcity: Why Health Economics Must Lead the Way

What is Health Economics?

Health economics is a field of study that examines how health resources are allocated, used, and financed. It helps decision-makers understand the trade-offs involved in investing in different health interventions by analysing their costs, benefits, and overall impact on population health. Through tools such as cost-effectiveness analysis and budget impact modelling, health economics supports evidence-based decisions that aim to maximise health outcomes with limited resources. In HIV prevention, this means ensuring that every intervention, from new biomedical tools to health service delivery, delivers real value for money and is accessible to the people who need it most.

Why Health Economics Literacy Matters for HIV Advocates
As an AVAC Clinical Trials Design Academy member and advocate for HIV prevention, developing health economics literacy is vital. It empowers advocates to engage meaningfully in decision-making spaces, to interrogate the value and feasibility of proposed interventions, and to ensure that community voices inform priority setting. With global health budgets tightening, advocates must be able to articulate why certain HIV prevention strategies deserve investment not only based on scientific merit but also on affordability, scalability, and equity. Health economics literacy strengthens our ability to champion interventions that are both innovative and sustainable, ensuring that the needs of communities are front and centre in research and policy design.

HIV Prevention in a Time of Scarcity: Why Health Economics Must Lead the Way
In many parts of the world, especially in low and middle-income countries, health systems are under pressure. Clinics are overcrowded, health workers are few, and budgets are stretched across countless urgent needs. Amid this, HIV prevention research continues, often funded by external donors and at times costing millions. But this raises an important and uncomfortable question: Can we afford to invest in research when so many basic health needs are unmet?

The answer isn’t simple. Health economics offers a way to think clearly and responsibly about these difficult trade-offs.

Making Hard Choices in Tough Times
HIV prevention research is essential for staying ahead of the epidemic. It has brought us game-changing tools like oral PrEP, HIV self-testing, and long-acting injectables. But these innovations come with a price. When that price competes with resources needed for treatment, staffing, or community outreach, priorities must be examined.

This is where health economics steps in. It doesn’t only look at whether an intervention works. It helps us ask whether this is the best way to use our limited resources. What else could we do with this money? Who benefits, and at what cost?

When Research Doesn’t Succeed
Not every clinical trial ends in success. In fact, many promising studies fail to deliver the hoped-for results. This can feel like a major loss, especially in settings where basic services like maternal health, tuberculosis care, or drug stock-outs remain critical concerns.

Still, “failed” research is not always a waste. It adds to the scientific knowledge base, helps refine future strategies, and can even save money by preventing poor investments down the line. Health economics helps make sense of these outcomes by evaluating the risk versus reward and guiding smarter research investments in the future.

A New Layer of Urgency: Frozen U.S. Aid and What It Means
The recent decision by the U.S. government to freeze funding for global AIDS programs such as PEPFAR adds a new layer of urgency. Many countries rely heavily on U.S. support to sustain life-saving HIV treatment, prevention, and community-based programmes. This freeze has already disrupted services and created uncertainty for millions of people living with or at risk of HIV. It underscores the fragility of externally funded health systems and reinforces the need for health economics to help countries plan for sustainability. Now more than ever, advocates and policymakers must be prepared to make evidence-based decisions that prioritise high-impact, affordable interventions and build greater domestic resilience in the face of funding volatility.

Allocating Resources Responsibly
Health economics can guide decision-makers to:

• Compare prevention options to find which are most cost-effective and scalable
• Model the long-term impact of introducing new tools into national health systems
• Ensure value for money by balancing innovation with equity and service delivery
• Forecast budgets so that new interventions do not become financial burdens

This is especially crucial in countries facing staff shortages and fragile health infrastructure. A prevention strategy that is too expensive or complex to deliver does not help in the long run, even if it is scientifically sound.

Innovation vs. Urgency: Do We Have to Choose?
We shouldn’t have to pick between innovation and meeting basic health needs. However, we do need to be strategic. Health economics provides a framework for making those decisions fairly, transparently, and based on data. It pushes us to ask whether the outcomes of our research efforts truly justify the costs, and whether the most vulnerable populations are seeing the benefits.

As global health funding becomes more constrained and domestic budgets face competing priorities, the case for applying health economics in HIV prevention becomes stronger. We need to ensure that every dollar, every trial, and every strategy contributes meaningfully to the bigger picture: a world where HIV prevention is not just about breakthroughs but about real, sustainable impact for people on the ground.

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