A recent article in the Wall Street Journal reports a gloomy view on the war on AIDS. War on AIDS
Several of the arguments used seem straightforward in hindsight: there was way too much emphasis on treatment and very little on prevention. With scarce resources (this includes "celebrity capital" to champion a cause), even if the expansion of treatment manages to slow down growth in prevalence rates, it is not surprising that many poor countries are incapable of providing treatment to all those infected. As treatment expansion rates are lower than the rates of new infections, most countries are now in a difficult position of having to ration life-saving treatments.
Earlier in the term we discussed the political economy of global health policies and how this can distort the allocation of resources both between diseases (eg: malaria, AIDS, diarrhea) and between preventive and curative approaches.
Why has it been so difficult to allocate resources to preventive care in HIV-AIDS in order to address the real source of the problem and contain it?
I don't believe that anyone has claimed that increasing levels of ARV treatment will decrease HIV prevalence. It will, of course, increase prevalence as more people will live longer lives with HIV.
ReplyDeleteIn fact, ARV treatment can have negative effects on behavioral changes - as the Wall Street Journal points out. The threat of death creates a credible commitment to behavioral change and ARVs dull this threat, since one can have a life expectancy very similar to someone who is HIV negative (with proper drug adherence). We see this effect with young gay males in rich countries as this cohort's HIV prevalence has shot up. These young men did not witness the epidemic that had killed so many of the previous generation - a generation which had little or no access to effective ARVs.
Preventative care hasn't worked because there is no agreement on the cause of the epidemic in Sub-Saharan Africa - and therefore no common strategy on preventative policy. The debate ranges from inter-generational relationships, concurrent relationships, non-circumcision, and poor medical practices...
The two examples of poor countries fighting HIV successfully are Cuba and Thailand. Both implemented their programs as military dictatorships that severely restricted the rights of their citizens in order to combat the disease. If the UK had HIV prevalence of 30% like Botswana, how far would the government restrict individual rights in order to combat the disease? I would hazard a guess that fairly draconian measures would be instated. Mandatory testing, mandatory reporting, controls on the movement of people, etc.
Having said all that, treating people with ARVs is economically vital. Those struck with HIV are generally in the prime of their lives and should be the most productive members of their economies. Making people healthy and economically productive is an important first step.
You are very right on a number of issues Drew. Designing preventive measures is politically unpopular amongst governments and donors. For governments because they are hard to enforce and for donors because they don't produce tangible results that demonstrate that the donor money is being well-spent. It is much easier for donors to measure the impact of their contributions through indicators like number of ARVs delivered, number of schools or roads built, etc. Perhaps a more balanced approach with multiple investments in preventive and curative care is what is in order!
ReplyDelete