The AIDS Pandemic: From Good to Bad or Bad to Worse?

Not your everyday Snapple fact: “For every 100 Africans put on ARV treatment, 250 more get infected with HIV.”

In order to spread awareness about the causes and consequences behind this harrowing statistic, the New York Times devoted four articles to discussing the AIDS pandemic and its purported exacerbation.

Donald McNeil argues that the international effort to vanquish the global HIV/AIDS pandemic is falling apart and that past gains may be reversed by present-day inaction.

He pinpoints four main reasons that have contributed to the dearth of money and drugs. First, the global economic meltdown detracted from donor budgets. In particular, PEPFAR and the Global Fund, the two main sources of AIDS funding, have been unable to scale up their finances enough to counteract the rapidly accumulating new infections.

Secondly, some donors have deliberately decreased their AIDS budgets, siphoning the difference to address more prevalent, easily treatable diseases—cost-effective measures, that is. For example, the Obama administration prioritized maternal health and childhood diseases over HIV/AIDS in its new PEPFAR-funded Global Health Initiative. (Incidentally, Esther Duflo published an article that advises donors to conduct measles vaccination campaigns rather than treat AIDS patients. Though supported by sound cost-benefit analysis, the recommendation was met with flak from AIDS activists, who, evidently, could not stomach and/or comprehend the whole “allocating scarce resources” thing.)

The third reason has cultural and behavioral roots; casual sex is becoming increasingly widespread and condom use is declining due to male supremacy, sugar daddies as well as plain misinformation. Furthermore, some patients on ARVs claim to have reverted to unsafe sex, citing complacency.

The last reason, more a sobering fact than a reason, is the inability of science to deliver a magic bullet in the form of a cure, vaccine or vaginal microbicide.

Treatment vs. Prevention

These four articles has spurred a heated debate on the Aid Watch comments thread; AIDS activists pitted against the Bill Easterly types who demand more attention for prevention.

He argues that the complementarity of treatment and prevention, repeatedly stressed by irate AIDS activists, is exaggerated. Easterly argues that prevention deserves a larger portion of our attention, because:

  1. Treatment is unnecessary and inefficient to achieve prevention
  2. Prevention is necessary to end the pandemic
  3. Prevention is politically and technically more difficult than treatment
  4. We actually don’t know how to prevent the spread of HIV (um?)

Mead Over at the Center for Global Development blog lauds the articles as a “welcome blast of frank information.” However, he maintains that the tone in some of the articles is misleading, painting a picture that is harsher than reality. Regardless of whether the fight against HIV/AIDS has plateaued or exacerbated, Over agrees with Easterly and calls for a new strategy to tackle the disease, with increased investments in prevention.


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