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Posts Tagged ‘PEPFAR’

“Someone Should Do Something…?” *

In Joe Raimondi on August 27, 2012 at 5:21 pm

* see Russell Brand for more on the title

Reading William Easterly’s The White Man’s Burden: Why the West’s Efforts to Aid the Rest Have Done so Much Ill and so Little Good (2006), I came across the following paragraph (quoted in full), regarding Western aid agencies’ AIDS prevention-treatment efforts over the past three decades:

AIDS treatment is another example of the SIBD syndrome – rich-country politicians want to convince rich-country voters that ‘something is being done’ (SIBD) about the tragic problem of AIDS in Africa. It is easier to achieve SIBD catharsis if politicians and aid officials treat people who are already sick, than it is to persuade people with multiple sexual partners to use condoms to prevent many more people from getting the disease. Alas, the poor’s interests are sacrificed to political convenience. When the U.S. congress passed Bush’s fifteen-billion dollar AIDS program (known as the President’s Emergency Plan for AIDS Relief, or PEPFAR) in May 2003, it placed a restriction that no more than 20 percent of the funds be spent on prevention, while 55 percent was allocated for treatment. (225)

SIBD syndrome, on some level, conveys a focus on treatment rather than prevention, which in turn suggests that the underlying causes of the problem are not addressed. At the governmental or organizational level, this translates into an emphasis on AIDS treatment rather than prevention: the symptoms are being addressed, but the root causes perpetuate. As noted, a fairly recent example is Bush’s PEPFAR program, which allocates funding for prevention and treatment at 20 percent and 55 percent, respectively. The sub-title of the chapter to which this passage belongs? “Path of Least Resistance.”

There’s a compelling economic component to arguments about treatment versus prevention (although Easterly acknowledges that “this past negligence is not an argument for or against any particular direction of action today – we must move forward from where we are now”): money spent on prevention is less costly and significantly more efficient. This is in no small part because it addresses the root causes of the problem (i.e. condom promotion)

He continues:

Why do we have a well-publicized Treatment Access Coalition when there is no Prevention Access Coalition? Why didn’t the WHO have a ‘3 by 5’ campaign intended to prevent three million new cases of AIDS by the end of 2005? The activists have been only too successful in focusing attention on treatment instead of prevention. A Lexis-Nexis search of articles on AIDS in Africa in The Economist over the previous two years found eighty-eight articles that mentioned ‘treatment’ but only twenty-two that mentioned ‘prevention.’ (226)

In terms of costs, the difference between treatment and prevention is striking: “overall, the World Bank estimates the cost per year for a variety of health interventions like these [i.e. voluntary testing] to range from five to forty dollars, compared with the fifteen-hundred-dollar cost of prolonging the life of an AIDS patient by a year with antiretroviral treatment” (223).

When figures like these are thrown around, we have to remember that sometimes the deceptively low cost obfuscates more complex, long-term issues, or hidden costs. This applies to both shockingly “cheap” figures for prevention as well as treatment. One example are first-line therapy drugs (an AIDS treatment) at $304 per year, which work for about as long before the virus builds up resistance. A more comprehensive figure, quoted by Easterly, is about $1,500 “per year per patient for delivering treatment to prolong the life of an AIDS patient by one year” (222)

SIBD syndrome seems to be linked to a focus on the treatment of AIDS rather than its prevention, for a variety of reasons (i.e. certain prevention/intervention mechanisms may be controversial for religious reasons in some parts of the African continent). Putting the focus on prevention, however, lends credence to one of Easterly’s primary points: the need to move away from Big Plans for Big Problems, and towards focused, efficient, piecemeal solutions that take account of context and local voices.