NEW YORK (Reuters Health) - Funding HIV prevention in Africa will ultimately save many more lives than treating people who already are HIV positive, at least until there is enough money available for both prevention and treatment, according to a report in the May 25th issue of The Lancet.

Providing a comprehensive response to the HIV pandemic would cost nearly $10 billion annually, Dr. Elliot Marseille of the University of California, San Francisco, and colleagues point out. So far, only $1.5 billion has been pledged to the UNAIDS Fund set up for this purpose.

"We need to talk about timing, and how to do the most good with the money we have if we don't get sufficient funds to (provide both treatment and prevention programs) in a safe and effective way," Marseille told Reuters Health.

Marseille and colleagues compared the costs of prevention with treatment. Taking into account only the cost of the drugs, which the Indian pharmaceutical company Cipla Ltd. is offering for $350 per person per year, the researchers estimated the effectiveness of treatment at $350 per disability-adjusted life year. The researchers note that this estimate doesn't take into account costs for distributing the drugs, known as highly active antiretroviral therapy (HAART), and patient care.

HIV prevention would include promotion of condoms for both men and women, targeting sex workers and men who have sex with men, providing counseling and testing, ensuring a safe blood supply, preventing the spread of the virus from mother to fetus, and controlling the spread of other sexually transmitted diseases.

The researchers estimate the cost-effectiveness of spending on HIV prevention at $12.50 per disability-adjusted life year.

This means, according to the authors, that prevention would be 28 times more cost-effective than treatment. In other words, for every life-year purchased with treatment drugs, 28 life-years could have been purchased with prevention, the California researchers note.

"Even with the rosiest conceivable cost estimate for HAART, we've shown that it still doesn't make sense to fund HAART while prevention programs are ignored," Marseille said.

The authors back up their argument, noting that prevention is a more cost-effective means of maintaining the health of parents, thus preventing orphanhood and maintaining workforce productivity.

Furthermore, they add, because of misconceptions about HAART's efficacy in preventing HIV transmission, both the US and Brazil have seen an upswing in sexual risk behaviors and an increase in HIV incidence after the introduction of HAART.

"I am not saying that people should not have access to antiretroviral drugs," Marseille emphasized. "However, it needs to be done right, and the required funding is simply not available now."

The investigators conclude, "Asserting the primacy of prevention is ethically valid because it rests on triage principles that dictate that where resources are limited in the short run they should be allocated where they will save the most lives."

SOURCE: The Lancet 2002;359:1851-1856.

Reference Source 89

For more information on how to prevent other diseases, use
PreventDisease.com's "Quick Prevention Resources".