Africa: AIDS Prevention Touted Over Treatment

Programs to prevent the spread of AIDS in Africa by helping people avoid infection should take priority over treatment of those who have the disease, according to a report in this week's Lancet (359;9320:1851-1856). Elliot Marseille, lead author, said: "Since the [UN] Global AIDS Fund has received commitments to date totaling only one-fifth of what will be needed every single year to provide for both prevention and treatment, we cannot duck the question, 'Where can this money do the most good?'"

Marseille, a public health researcher and health economist at the Institute for Health Policy Studies at the University of California-San Francisco, and colleagues presented data and calculations showing that in the 48 African nations south of the Sahara desert, it is 28 times cheaper to prevent HIV infection than to treat a patient with AIDS.

The authors urge spending money to ensure a safe blood supply; using drug therapy to prevent mother-to-child transmission of HIV; voluntary counseling and testing; and sex- worker interaction programs. The paper indicates that a study in Kenya showed every $8 to $12 spent on workers for sexual disease transmission control and on condoms prevented one case of AIDS. Even cut-rate drug treatment for AIDS costs $350 yearly per patient in Africa.

Among those who object to the notion that antiretroviral therapy should not be publicly funded for Africans is Vincent Idemyor, a clinical pharmacologist and an authority on highly active antiretroviral therapy (HAART). "Basically [the authors] are implying that the 25 million plus people who are infected in sub-Saharan Africa should die. I am surprised that the Lancet would publish an article like this. There is enough money in the world to handle AIDS cases in sub-Saharan Africa, if there is a will," Idemyor said. "Both approaches are important. Prevention is important and treatment is important. But you cannot say that prevention should be funded before HAART. That's ridiculous," he added.

In some ways, the Lancet article authors seem to agree with Idemyor. "The primary message from what we're doing is that the international fund is tremendously under financed at this point and that is a huge moral failing of the industrialized world," Kahn told UPI.

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