One characteristic of the global AIDS response is that funding is mostly limited to a small number of very large donors: Global Fund, World Bank, PEPFAR, and the Gates Foundation. These organizations make grants which are generally very large -- several million dollars each or more. Complementary small grants programs, common in other policy sectors (such as environment or education) hardly exist in global AIDS.

This creates two problems. First, many good ideas and opportunities require smaller amounts of funding than these organizations can provide. Second, and more importantly, programs and individuals need time to grow and demonstrate their worth. Only in an environment of small grants can good ideas flourish.

It is unrealistic to expect these organizations to develop small grants capabilities -- they are configured wrong for the task. What should happen instead is that one or more of them fund a small grants facility -- call it the Global AIDS Foundation -- to fund project ideas and individuals in the $5,000 - $500,000 range. Such a foundation could operate efficiently at $20 - $50 million per year.

There are good examples of such "small grants" foundations supported by larger entities. In the 1950s the US Government founded the Asia Foundation to support programs in across Asia, an effort which served as a model for subsequent organizations. Most recently, USAID (and subsequently other donors) have supported the Eurasia Foundation, which operates small grants programs in twelve countries of the former Soviet Union.

The collective funding for global AIDS totals billions of dollars annually. The entire effort would benefit from an effective small grants facility.

Is setting up and running a policy-oriented blog worth the effort? AIDS Matters was launched three months ago. Here are current statistics:

• Monthly unique users: ~800
• Countries: ~40
• Other web sites citing AIDS Matters: 16
• Effort: ~2-3 hours per week

While traffic and activity is still limited, it is more than I'd expect at this stage. Running a weblog has also provided two other benefits. First, I pay more attention to noting and recording key ideas that otherwise would escape. Secondly, I find I reference postings frequently in personal correspondence.

Which countries receive too little media attention given their AIDS prevalence? We know how much press attention countries receive overall (at least as based on citations in the Kaiser Daily HIV / AIDS Report, published since 1999 and probably the most widely read AIDS news resource). We also know how many people have HIV in each country (as cited by UNAIDS). If we combine these two data types, we can determine "media citations per million cases", giving an idea of relative media attention a country receives. Here is a table of the 40 developing countries with the highest incidence of AIDS ranked from "most neglected by the media" to "least neglected by the media":

	People with HIV	Kaiser Citations	Citations per million cases
Madagascar	140,000	6	43
Sudan	400,000	20	50
Colombia	190,000	10	53
Nigeria	3,600,000	208	58
Chad	200,000	12	60
Dem. Republic of Congo	1,100,000	72	65
Central African Republic	260,000	20	77
Burkina Faso	300,000	24	80
Burundi	250,000	20	80
United Rep. of Tanzania	1,600,000	133	83
Ethiopia	1,500,000	126	84
India	5,100,000	449	88
Cameroon	560,000	57	102
Mozambique	1,300,000	144	111
Malawi	900,000	111	123
Zimbabwe	1,800,000	224	124
Cote d'Ivoire	570,000	79	139
Myanmar	330,000	47	142
Ukraine	360,000	57	158
Lesotho	320,000	63	197
Mali	140,000	28	200
Ghana	350,000	76	217
Russian Federation	860,000	189	220
Angola	240,000	56	233
Zambia	920,000	236	257
Kenya	1,200,000	309	258
South Africa	5,300,000	1461	276
Guinea	140,000	46	329
Haiti	280,000	100	357
Brazil	660,000	237	359
Rwanda	250,000	97	388
Viet Nam	220,000	103	468
Swaziland	220,000	105	477
Namibia	210,000	102	486
China	840,000	445	530
Cambodia	170,000	102	600
Thailand	570,000	468	821
Botswana	350,000	291	831
Uganda	530,000	489	923
Mexico	160,000	159	994

Nigeria and Democratic Republic of Congo are particularly notable members of this list, representing 10% of the world's cases of HIV between them but garnering only 1% of press citations.

Full spreadsheet with these data is available here.

After several years in gestation, a new World Bank report on AIDS treatment options in India was recently released. HIV/AIDS Treatment and Prevention in India specifically addresses ART, and which policies the Indian government should adopt regarding the procurement and provision of AIDS medicines.

While the press coverage of the report tended to focus on projections of infection ("five million new cases a year in India in 2033"), the main story of the report (and underlying model) is really something else: ART will succeed or fail depending on what happens to condom usage. If ART promotes condom usage (because of tying treatment and prevention programs), then ART will lessen new infections. If ART discourages condom usage (because of disinhibition effects), then ART will increase new infections.

While AIDS economists can pick at the model, and while the Bank is a lightening rod for most policy reports such as this, the key messages regarding the interplay between treatment and prevention shouldn't be overlooked. In addition, the report serves as a well-presented primer on ART policy in environments with low but growing prevalence of HIV -- which is to say, most countries of the world. Kudos to the authors: Mead Over, Peter Heywood, Julian Gold, Indrani Gupta, Subhash Hira, and Elliot Marseille.

As AIDS treatment programs grow throughout the developing world, drug procurement costs will represent a larger and larger percentage of AIDS budgets. Having an idea of future drug costs would be very helpful for planning. AIDS drug costs, however, have proven hard to predict. How might policymakers better estimate future drug prices?

One way would be to build an "AIDS Drug Futures Market", an online venue in which users can compete in predicting drug prices. Such futures markets have proven useful in predicting other pharmaceutical prices, such as in the market run by NewsFutures.com. (Futures markets have proven effective in predicting many things, such as presidential elections and economic growth -- all described in the excellent book "The Wisdom of Crowds").

The Global Fund is now providing excellent retrospective data on AIDS drug prices. A futures market could help provide prospective estimates, allowing policymakers to maximize resources.

In The Tipping Point, Malcolm Gladwell describes how ideas spread through society, following "epidemic-like" dynamics. At one point he includes a provocative passage about AIDS, and what would have happened had we not discovered the virus. I include it here as food for thought:

"Not long after The Tipping Point came out, I happened to talk to an epidemiologist, a man who had spent the better part of his professional life battling the AIDS epidemic. He was a thoughtful fellow, and frustrated in the way that someone would be who has had to deal, on a daily basis, with such a terrible disease. We were sitting in a cafe talking about my book, which he had read, and then he said something startling: "I wonder if we would have been better off if we had never discovered the AIDS virus at all?" I don't think he meant that literally, or that he regretted the countless lives that have been saved or prolonged by anti-HIV drugs and the AIDS test. What he meant was this: that the AIDS epidemic is fundamentally a social phenomenon. It spreads because of the beliefs and social structures and poverty and prejudices and personalities of a community, and sometimes getting caught up in the precise biological characteristics of a virus merely serves as a distraction; we might have halted the spread of AIDS far more effectively just by focusing on those beliefs and social structures and poverty and prejudices and personalities."

AIDS policy professionals have many questions that only other AIDS policy professionals can answer. The only resource we've seen linking AIDS professionals through questions and answers is the IAEN, which does a relatively good job in the Member Question Board. Ideally, every major site (UNAIDS, Global Fund, World Bank) would have such a question and answer board. Even more ideally, all of these boards would be linked. One can imagine a community of AIDS professionals posting thousands of questions and comments per month from 100+ countries.

As a step towards this vision, the IAEN is now syndicating the Question Board technology and content to allow any site to join the conversation. As an example, we've now included the syndicated site within AIDS Matters. We're hopeful other groups will follow suit (contact Jim Cashel). Feel free to join the conversation!