The economics of AIDS numbers

[Guest guest]

The economics of AIDS numbers

1 Dec, 2007, 0430 hrs IST, By Anit Mukherjee

The year 2007 has been a good one as far as AIDS numbers are

concerned. In September, the number of people with HIV/AIDS in India

was officially revised downwards by half.

Then, last week, UNAIDS `adjusted' the estimated worldwide number of

sufferers from 40 million last year to 33 million in its latest

epidemiological report. It stated that major reason for this

reduction in the worldwide numbers is because of the fact that there

are 3 million less Indians with HIV than previously thought.

The flip side of the story is that these adjustments are purely

statistical, taking into account the better quality of data that has

been generated over the past several years through household surveys

that tested people for their HIV status.

This complements the annual `sentinel surveys' that collect data

yearly from designated sites in India and elsewhere. Experts agree

that the current numbers are closer to reality. It is therefore time

to move beyond the endless debate and focus on more pressing issues

that will confront policy makers, program managers and the civil

society in the years to come.

There is no substance in the argument that AIDS gets too much of

resources at the expense of other diseases such as tuberculosis,

malaria or cholera. The total budget for the ongoing third phase of

the National AIDS Control Program (NACP-3) at current exchange rate

is about $ 500 million per year, which translates to $1 per adult

person in the most vulnerable age group.

This allocation is spread over a variety of programs – from blood

safety, to information campaigns, condom distribution, anti-

retroviral treatment, data collection etc. A mere financial

accounting does not do justice to the externalities generated by

taking into account such a wide variety of activities.

However, not more than one-fourth of the resources are spent on

critical programmes aimed at groups that need most attention such as

sex workers, their clients, drug users, homosexual and transgender

communities. The challenge is to accept the nature of the epidemic,

its transmission pattern within the population and put adequate

resources where it is needed the most. The reduction in the numbers

should be a catalyst for a more focused approach, not less.

Very little is known about the impact or efficiency of HIV prevention

programs. While medical science insists on rigorous randomised trials

to approve drugs and vaccines, HIV/AIDS prevention measures rarely

generate data on how many infections have been prevented. From an

economic point of view, it is possible that programs that are not

cost-effective have been carried out longer than necessary, while

others have gone underfunded. More importantly, it is practically

impossible to calculate the resources needed to achieve the best

possible outcome.

The reduction in the numbers also means that there are fewer people

who need to be put on anti-retroviral treatment than previously. NACP-

3 has set aside 12% of the total budget for this purpose with the

assumption that 5.2 million, and not 2.5 million, were infected.

It may now be possible to provide universal first-line, and a

proportion of second-line costs with the same budget. The crucial

factor would be the reduction in the price of second-line drugs which

now costs nearly 10 times that of first-line treatment. The latest

set of numbers open a window of opportunity for a more careful

analysis of the cost and benefits of anti-retroviral treatment, and

the effectiveness of the HIV/AIDS prevention strategy as a whole.

Mr Mukherjee is a fellow at NIPFP, New Delhi, and researcher for the

Commission on AIDS in Asia.

http://economictimes.indiatimes.com/News/PoliticsNation/The_economics_

of_AIDS_numbers/articleshow/2586667.cms