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Monday, 28 May 2007

ARVs versus Prevention Revisted

A while back I did a blog on "Should we spend more money on prevention or ARVs?" . The discussion centred around Professor Canning's assertion 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. Professor Canning's brilliant paper published last year in the Journal of Economic Perspectives is now available online entitled "On the economics of HIV/AIDS in low income countries: the case for prevention".


  1. There needs to be a complete approach. If ARVs are not available what is the point of getting tested? The problem we have right now is that people don't talk about AIDs because of the stigma but with ARVs the stigma is less.

    It obviously makes sense at how to make ARVs cheap and easily available.

  2. "If ARVs are not available what is the point of getting tested?"

    Its a very valid point.
    ARVs appear necessary to incentivise people to get tested. As you say people only "see" the Doctor with the aim of getting cured. If there's no cure in sight it could discourage people.

    However, on further reflection if I may just step in the big shoes of Prof Canning - his response would probably be two-fold:

    First, there are other cheaper alternatives of incentivising people to get tested. For example Churches in Zambia are now saying you cannot marry in our church unless you are tested. Its a small incentive but am sure other incentives can be put in place.

    Secondly, knowing 'HIV status' does not necessarily lead to preventive actions on the part of the individual (to prevent others from being infected). What is needed therefore is to ensure that the individual never gets HIV in the first place. Canning reckons that spending on those programmes which prevent HIV (in the current absence of cheaper ARVs) provides a superior outcome to spending on ARVs.

    I think Prof Canning would certainly agree that in the long term we should strive for cheaper ARVs - but that remains an elusive quest.

    But you are absolute right - we cannot simply abondon ARVs without sufficient incentive for people to get tested. Good point.

  3. I would say funding for prevention is more important than trying to get ARV's at this moment, but this more of 'a chiken and the egg' type thing. If people don't take their ARV's effectively, then it's a waste of time to even administer them. Also many times people seem to think they are cured when they feel "well" on the ARV's and can tend to do careless things.
    Asking people to check their status before marriage might be a little too late these days because many people have sex before marriage.
    ARV's are NOT a cure-- even though looking at magic johnson might have other's thinking otherwise:)


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