AIDS in the Developing World: Don't Overlook the Ounce of Prevention

... [At] the recent International AIDS Conference in Barcelona ... Peter Piot (director of UNAIDS), Jeffrey Sachs (director of the Columbia University Earth Institute), Nelson Mandela and Bill Clinton all declared that there is a moral imperative for developed nations to provide the funds to make [HIV] treatment available.

" ... What if the money doesn't come? Notably absent from the many public announcements coming from Barcelona was any further pledge of funds from donor countries or organizations. The financing for the fight against AIDS is far short of the UN's goal of $10 billion a year for global coverage of treatment and prevention. ...

"Even if AIDS drugs were free, the goals of prevention and treatment of HIV cannot be fully met with existing resources. Inevitably, the expense of government-sponsored treatment programs will cut into activities to prevent HIV. Using the cost-effectiveness analysis that is under attack, $1 spent on prevention can save 100 times as many years of life as $1 spent on treatment. Yet, most African countries are still woefully behind in providing HIV prevention programs, let alone providing AIDS drugs to large numbers.

"AIDS funding is still a zero-sum game between competing needs -- those with HIV and those at risk of infection. Advocates of treatment correctly state that treatment makes prevention more effective. It also makes it much more expensive. Thailand and Uganda have proven that the HIV epidemic can be turned around without huge budgets and without treatment, so the implication that prevention can only be effective with treatment is inaccurate.

"AIDS advocates may be afraid that planning for continued funding shortfalls will make it easier for donors to shirk their duty to provide more resources. But this kind of all-or-nothing strategy is gambling with millions of lives.

" ... This epidemic is too dangerous not to have a plan B. What should be done? AIDS advocates -- and all reasonable people -- should continue to advocate more funding for fighting HIV worldwide. But until that money arrives, we need a plan B. And that should be to continue to focus primarily on the prevention efforts that we know to be effective."

Obstetrician Malcolm Potts is a Bixby Professor in the School of Public Health at the University of California-Berkeley and co-director of the Bay Area International Group. Russell Green is a Ph.D. candidate in economics.

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