Living in Botswana, it’s hard to ignore it. The estimates vary (as do the sampling techniques), but the most recent UNAIDS survey places Botswana’s HIV prevalence at 24.8%. In Gaborone, the nation’s capital and largest city, the HIV rate is estimated at 40%. Things have actually gotten better since 2002 when the government started distributing free antiretrovirals to its HIV-positive citizens. While not curative, when taken properly these drugs can keep the virus at bay for decades. They also have the added benefit of reducing transmission when HIV-positive individuals have sex with those who are HIV-negative. While Botswana’s life expectancy was 32 years in 2003, today it has rebounded to 61.
|It takes more than pills to keep you healthy.|
Further, as I discussed in my last post, with limited funds dedicated to global health, being effective isn’t enough; interventions must be more cost-effective than the other plausible alternatives. That way we are doing the most good for the most people. Antiretrovirals can transform lives, but in starting a patient you are making a lifelong commitment to treatment. These drugs can make people live a lot longer, but in doing so, necessitate more years of expensive treatment. This is an excellent problem to have (if only we could do so much for people with lung cancer or ALS), but one with many long-term implications. If we cannot afford to offer drugs over the long term, then patients will eventually fall ill again: levels of the HIV virus begin to rise within days of stopping the medication, undoing all the good gained from years of treatment. Worse yet, interruptions of treatment breed resistance, making the virus harder (and more expensive) to contain in the future. And, while it’s wonderful that there exist drugs that can keep someone with HIV alive for decades, we have to consider the cost of those drugs over that time and what we might have been able to do with all of that money over that same period. It’s not that treating HIV is a bad deal, per se (at about $1,000 per life year gained it would be a no-brainer in America), it’s just that this money could be better spent elsewhere.
|This guy's got bigger problems than HIV to worry about.|
|These beds were designed for patients with cholera. Still doubt the lethality of diarrhea?|