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Saturday, 3 February 2007

Aids : Should we spend more money on prevention or ARVs?

The argument on this old question appears to have been settled.

I recently read an article by David Canning entitled "on the economics of HIV/AIDS in low income countries: the case for prevention". [Journal of Economic Perspectives Summer 2006]. David argues that rather than spending more money on trying to heal aids patients with ARVs, poor countries like Zambia faced with the choice to either spend money on prevention through contraception and other things or spending more money on ARVs, should do more of the former, than the latter. He argues that we should spend more money on prevention instead of wasting it on ARVs, because we have so little money available to tackle the menace of AIDs.

To support his argument, Canning carries a simple analysis based on data from 20 African countries including Zambia. He shows that prevention cost $859m managed to save 30.9 million lives, whilst ARVs costing $1,350m managed to save 2.4m lives. His argument is therefore that it is more cost effective to spend money on prevention through condoms and nutrition, campaigns etc, than treating AIDs patients with costly ARVs.

I must say that I find Canning’s analysis highly persuasive - Zambia has few resources and money to waste: Shouldn’t our Government be listening, and start spending more money on prevention and stop people getting AIDs than on ARVs? The emphasis here is on “more”. No one doubts that there’s a role of some sort for ARV spending, but clearly MORE resources should be put into PREVENTION as it yields a better benefit cost ratio that on ARVs. I realise that this may not be a popular decision for any Government to make, but until Zambia starts making these bold and painful decisions we won’t make further progress. Unfortunately, this is another area where the recent 5th NDP is silent. It provides no information on the balance of spend.

I think the Opposition Party owes it to the people to press Government to publish its plans on its future spending plans on prevention compared to ARVs, and to argue persuasively using economic evidence similar to the work by Canning, that there is indeed a need to 90%+ spending on prevention. We must not be held hostage by foreign interests who prefer us to waste money on ARVs because it keeps their Pharmaceuticals companies in business.


  1. Whilst such analysis is useful, we have to bear in mind that Aids is a human problem, and it isn't always necessary for us to adopt a mechanical approach.

    But I do agree we must consider the costs and benefits of whatever actions we take with respect to the virus!

    Nice blog!

  2. Johanes Chooma9 April 2010 at 14:36

    While the argument is quite convincing to demand that we devote up to 90% or more funding to prevention activities is asking for too much in my view.

    It should not just be about comparing numbers (not too clear from where they were derived) but also about the culmulative benefit that comes from prolonging the lives of the economically active population.

    The cost of ART has reduced drastically over the years and a large portion of the public health ART programme is donor supported which again brings the issue of sustainblity at play, thus i agree that a more clearer indication of government spending will be needed on the matter.


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