Treatment is Prevention

So you may have noticed there have been no entries on South Africa, despite my arrival home from a month-long stay there just a week ago. Let’s just say that crime is still very much a problem in Capetown, and the entries that I had been planning to upload are now no longer in my possession. (It’s still a bit of a sore spot.)

But moving on, let’s turn out attention to an incredible study that was released a few days ago that has been sweeping the news. ARV treatment for AIDS patients reduces their risk of transmitting the disease to others. Read about it here.

Coming off of a study abroad trip focused on global health, this discovery cuts right into an age old debate in the field of global health funding: should we direct efforts to treatment or prevention? WHO officials often call for funding to be focused on prevention efforts to achieve a “sustainable” model. Activists often counter that making such a decision is tantamount to a death sentence for those already suffering from the disease. This new study indicates that we shouldn’t be thinking in such distinct dichotomies—with AIDS, treatment is prevention.

This pattern is not just confined to AIDS. Paul Farmer, the hero of medical anthropologists and activist-doctors, has written a number of fantastic essays on a new paradigm of treatment for drug resistant tuberculosis. (If you want the more literary, layman’s version, read Mountains Beyond Mountains.) Today, a standard course of TB treatment costs around $20. But a course of treatment for multidrug-resistant TB costs over $5000, and for extensively drug-resistant TB, even more (Center for Global Development). In direct confrontation of well-entrenched global funding protocols—some of which advocate giving basic antibiotics to patients for whom they clearly won’t be effective—Farmer makes an argument for spending those thousands of dollars for each and every patient afflicted with MDR-TB and XDR-TB. His argument is twofold. First, that a failure to address the spreading epidemic of drug resistant TB now will lead to a much bigger problem of widespread drug resistance down the road—a phenomenon already witnessed in places such as Russian prisons. In essence, for drug resistant TB, treatment is prevention. And second, that when authorities and policy-makers claim that “resources are limited”, one must question whether we really have garnered as much funding as we potentially could.

Going back to the question of AIDS, this recent study is promising but by no means does it end the funding debate. In fact, it may even exacerbate it. Changing best practices to reflect this latest finding would mean putting millions of new HIV patients on treatment who may not have “required” it by previous standards. And that’s a lot of money. Despite fierce negotiations by players such as the Clinton Foundation and various governments that have brought the cost of first line ARVs down to about $300 per person per year, a WTO agreement on intellectual property law stifles generic competition for second line drugs (AVERT). HIV/AIDS is already losing steam as a “hot topic” for international donors…will this recent finding refuel the funding momentum or drive funders to throw up their hands?

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