HIV is no longer that scary — in the first world, that is. For those living in Sub-Saharan Africa, contracting HIV is nothing less than a death sentence. Countries like Ethiopia, Kenya, Malawi, Nigeria and others of Africa host two-thirds of all HIV patients, and their numbers seem to be swelling amid poor funding. One study estimates that over the next 35 years, nine African countries would have to spend $98 billion to $261 billion to buy drugs and prevent infections.

Credit: Flickr/ U.S. Army

Researchers at Harvard’s TH Chan School of Public Health calculated the ongoing costs of controlling HIV from 2015 to 2015 in Ethiopia, Kenya, Malawi, Nigeria, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe. This is where 70% of HIV infected Africans live. Writing in the journal BMJ Open, the authors conclude “future obligations are too substantial for most SSA countries to be met from domestic sources alone. New sources of funding, in addition to domestic sources, include innovative financing. Debt sustainability for sustained HIV response is an urgent imperative for affected countries and donors.”

The king’s share of all of these running costs is expenditure on  antiretroviral therapy (ART), drugs which have increased in cost substantially.

Though expensive, HIV prevention and treatment was found to be cost effective in at least one African country — South Africa. Since  the National Department of Health launched a national HIV/AIDS treatment program in 2004, more than two million South African have been treated for HIV. Studies found that using ART was still less expensive than medical care without ART.

“The problem of predictable and sustainable funding must be resolved,” professor of global health systems and one of the paper’s authors Rifat Atun said with conviction. “There is an ethical responsibility to continue financing for those receiving ART, and not abandon them to death.”