Perverse Incentives for South African AIDS Patients

April 08, 2006

The Wall Street Journal (subscription required) covered the increasing - and disturbing - phenomenon of South African AIDS patients who deliberately discontinue their free antiretroviral treatment in order to qualify for government-funded disability payments, which typically depend on a dangerously low CD4 count. So individuals are faced with the desperate choice between their long-term health and short-term financial needs - and there is anecdotal evidence that they are increasingly choosing the latter, with up to 30% of patients at one AIDS clinic no longer taking their medication for this purpose. These and other such patients intend to resume their ARVs once they have been approved for payments. So as it stands, this could have the effect of deepening the South African AIDS crisis by not only lowering the treatment rate but also by increasing drug resistance. No matter how well-meaning, this disability system needs to be reevaluated in light of such a strong perverse incentive.


CGD blog posts reflect the views of the authors, drawing on prior research and experience in their areas of expertise. CGD is a nonpartisan, independent organization and does not take institutional positions.