In the world of deadly maladies, I find AIDS comes second to cancer. But then, even cancer doesn’t rank very high on my priorities list because of the overwhelming poverty in the world. The fact that food and water are scant in as much as (% of the world) pushes AIDS into a far corner of my mind.
I see problems from their origin. The spread of AIDS is correlated to poverty, and poverty is at its worst when food, water, and shelter (the necessities of life) are limited. When food and water are limited, overall health declines. Of course, AIDS can’t be spread with a cough, but generally good health in an area comes with health education (just use condoms—it’s that simple). If one focuses their resources on combating unclean water (or worse—not any at all) then accumulating food will become easier. Once food and water are not so hard to come by, then overall health will improve and more focus can be on working and providing health care. If you’re repairing a shambled building, you don’t start with the top—you build from the bottom.
In addition to focusing resources on the original issues, one could increase the efficiency of combating poverty and the ills that come with it by privatization. Normally the argument against privatization is that businesses are out to make a profit. Of course, that would be the same in the case of a privatized effort against AIDS, but one would assume that if an entrepreneur decided to make a company to do such a thing, his mission isn’t solely to make $1 million personal profit per year. Not only are private industries usually more efficient than public, but it also wouldn’t drain money from the government. We all know our government is in the hole pretty big right now…
Overall, I wasn’t impressed with the two speeches on AIDS. First of all, they were glaringly conflicting in some spots. For instance the first speaker alluded that all AIDS medicine must be refrigerated. This would make combating AIDS quite difficult and costly, as one would have to tote around a cooling system. However, the second speaker at PEPFAR made the idea that all AIDS medicine needed to be refrigerated seem like a silly question! Of course there’s non-refrigerated medicine! This brought up a question of efficiency: Apparently there are different varieties of medicine, so what is the distribution that PEPFAR is using? One would assume that the non-refrigerated variety is more expensive, so is PEPFAR inefficiently using this non-refrigerated variety where they could easily use the refrigerated? How exactly is PEPFAR using their money?
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ReplyDeleteI think one of the key points Liz made in terms of why the prevention and treatment (including this idea of "prevention by treatment" that both speakers touched upon) of HIV/AIDS should be a priority is that the disease is 100% preventable. The same certainly cannot be said of cancer and it is a much more challenging statement to make about poverty (especially when standards of living are relative).
ReplyDeleteThe point to be made here is that while HIV infection rates may well be *correlated* with poverty, the case for causation is much harder to make: if we can successfully slow the spread and treat the symptoms of HIV/AIDS *without* having to raise GDP's in the developing world (as admirable a goal as that may be), it certainly seems like there is a pragmatic case to be made for focusing some of our resources on this latter, more attainable goal. What do you think?
But you're right that poverty, development, and HIV/AIDS cannot be treated completely separately. Indeed, this report suggests that alleviating poverty will indeed facilitate the delivery of HIV/AIDS treatment: http://www.hawaii.edu/hivandaids/Challenges_in_Delivering_Antiretroviral_Treatment_in_Resource_Poor_Countries.pdf.
You suggest a privatized alternative to PEPFAR. Such an effort would surely require a tremendous amount of private will -- an amount that was empirically lacking prior to the implementation of PEPFAR. Do you think private citizens and corporations would be more willing to match PEPFAR's funding and resources now as opposed to ten years ago? Don't forget the recession hit the private sector hard too. Are you confident we can count on it for HIV/AIDS relief that does not provide any direct benefits for it?
As for the different AIDS medications (antiretrovirals), some (specifically, most protease inhbitors, like Emtricitabine, Enfuvirtide, and Lopinavir/ritonavir which is currently being used in South Africa) do require refrigeration, while others do not. Which ARV is dependent on cost, the specific strain of the virus, which other medications the HIV/AIDS patients have already used, availability, tolerability, efficacy, etc. so in some cases, the refrigerated drugs are the only possibility. (http://www.searo.who.int/LinkFiles/AIDS_Fact-Sheet.PDF)