On reading “Global HIV/AIDS Policy in Transition” in the June 11 issue of Science, I was reminded of Al Gore’s catchwords for global warming (“An Inconvenient Truth”) because the authors – John Bongaarts and CGD Senior Fellow Mead Over – openly confront a very uncomfortable fact: money spent on treating AIDS patients saves far fewer lives than money spent on a wide range of other urgent health interventions.This is not news. I remember over a decade ago when I first saw cost-effectiveness calculations for anti-retroviral treatment compared with bednets, beta-blockers, tobacco cessation, or promoting use of condoms. While cost-effectiveness calculations are definitely not the sole basis on which to allocate resources across the health sector, they do give us critical information about the tradeoffs we face when managing constrained resources. And in most low-income countries, despite the past decade’s increase in foreign aid, health spending is still highly constrained.My reaction was to play the ostrich and pretend it was someone else’s problem. I imagined that resources would go to prevention as well as treatment and we would muddle through. Besides, there were a number of comforting arguments to qualify the cost-effectiveness calculations – HIV/AIDS advocacy was helping to increase the total resources going to global health initiatives, negotiations were bringing down the prices of anti-retroviral drugs, the ability to offer treatment provided an incentive for testing and counseling, and so on.But I never imagined the magnitude of the HIV/AIDs response (analyzed and documented by CGD’s HIV/AIDS Monitor, among others) – still too small to fully address the problem and yet, at the same time, overshadowing and putting stresses on other parts of the developing world’s health systems.But Bongaarts and Over neither flinch at the inconvenient truth nor do they use it simplistically to argue against treatment. Instead, they are calling for a more balanced perspective that considers the ethical imperative of applying funds where they can do the most good alongside the need to uphold commitments to those who are already receiving treatment. This is a realistic call to “protect and expand resources for the most cost-effective health interventions, focusing on HIV prevention, childhood immunization, malaria, tuberculosis, maternal mortality, and family planning,” as well as a proposal for a coherent HIV/AIDS approach that “preserves recently achieved mortality reductions while lowering the annual number of new infections to less than the annual number of AIDS deaths.” (This latter phrase is what Over has termed “The Global Aids Transition,” showing that the epidemic cannot be understood without simultaneously considering the relationship between new infections, treatment and the mortality rate.)Putting our heads in the sand may be an effective way to avoid inconvenient truths, but it’s an ineffective way to save lives.
CGD blog posts reflect the views of the authors, drawing on prior research and experience in their areas of expertise.
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