March 01, 2006 — By the Earth Policy Institute
WASHINGTON, D.C. — "The key to curbing the AIDS epidemic, which has so disrupted economic and social progress in Africa, is education about prevention. We know how the disease is transmitted; it is not a medical mystery. In Africa, where once there was a stigma associated with even mentioning the disease, governments are beginning to design effective prevention education programs. The first goal is to reduce quickly the number of new infections, dropping it below the number of deaths from the disease, thus shrinking the number of those who are capable of infecting others," says Lester Brown, President of Earth Policy Institute (see http://www.earthpolicy.org/Books/Seg/PB2ch07_ss5.htm).
Concentrating on the groups in a society who are most likely to spread the disease is particularly effective. In Africa, infected truck drivers who travel far from home for extended periods often engage in commercial sex, spreading HIV from one country to another. They are thus a target group for reducing infections. Sex workers are also centrally involved in the spread of the disease. In India, for example, the country’s 2 million female sex workers have an average of two encounters per day, making them a key group to educate about HIV risks and the life-saving value of using a condom.
Another target group is the military. After soldiers become infected, usually from engaging in commercial sex, they return to their home communities and spread the virus further. In Nigeria, where the adult HIV infection rate is 5 percent, President Olusegun Obasanjo requires free distribution of condoms to all military personnel. A fourth target group, intravenous drug users who share needles, figures prominently in the spread of the virus in the former Soviet republics.
At the most fundamental level, dealing with the HIV threat requires roughly 10 billion condoms a year in the developing world and Eastern Europe. Including those needed for contraception adds another 2 billion, but of the 12 billion condoms needed, only 2.5 billion are being distributed, leaving a shortfall of 9.5 billion. At only 3¢ each, or $285 million, the cost of saved lives by supplying condoms is minuscule.
The condom gap is huge, but the costs of filling it are small. In the excellent study "Condoms Count: Meeting the Need in the Era of HIV/AIDS", Population Action International notes that "the costs of getting condoms into the hands of users – which involves improving access, logistics and distribution capacity, raising awareness, and promoting use – is many times that of the supplies themselves." If we assume that these costs are six times the price of the condoms themselves, filling this gap would still cost only $2 billion.
Sadly, even though condoms are the only technology available to prevent the spread of HIV, the U.S. government is de-emphasizing their use, insisting that abstinence be given top priority. While encouraging abstinence is important, an effective campaign to curb the HIV epidemic cannot function without condoms.
One of the few African countries to successfully lower the HIV infection rate after the epidemic became well established is Uganda. Under the strong personal leadership of President Yoweri Museveni, the share of adults infected has dropped from a peak of 13 percent in the early 1990s to 4 percent in 2003. More recently, Zambia also appears to be making progress in reducing infection rates among young people as a result of a concerted national campaign led by church groups. Senegal, which acted early and decisively to check the spread of the virus, has an infection rate among adults of less than 1 percent today. It is a model for other African countries.
The financial resources and medical personnel currently available to treat people who are already HIV-positive are severely limited compared with the need. For example, of the 4.7 million people who exhibited symptoms of AIDS in sub-Saharan Africa in June of 2005, only 500,000 were receiving the anti-retroviral drug treatment that is widely available in industrial countries. However, this was up threefold from a year earlier. The increase is part of a worldwide effort by the World Health Organization to reach 3 million people in low- and middle-income countries by the end of 2005, known as the 3 by 5 Initiative.
There is a growing body of evidence that the prospect of treatment encourages people to get tested for HIV. It also raises awareness and understanding of the disease and how it is transmitted. If people know they are infected, they may try to avoid infecting others. To the extent that treatment extends life, and the average extension in the United States is about 15 years, it is not only the humanitarian thing to do, it also makes economic sense. Once society has invested in the rearing, education, and on-job training of an individual, the value of extending the working lifetime is high.
Treating those with HIV infections is costly, but ignoring the need for treatment is a strategic mistake simply because treatment strengthens prevention efforts. Africa is paying a heavy cost for its delayed response to the epidemic. It is a window on the future of other countries, such as India and China, if they do not move quickly to contain the virus that is already well established within their borders.
Adapted from Chapter 7, "Eradicating Poverty, Stabilizing Population," in Lester R. Brown, Plan B 2.0: Rescuing a Planet Under Stress and a Civilization in Trouble (New York: W.W. Norton & Company, 2006), available on-line at www.earthpolicy.org/Books/PB2/index.htm.
Director of Research, Earth Policy Institute
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