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The Case for Treatment

By Sanjay Basu and David Stuckler
January/February 2011
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Essay
No Good Deed Goes Unpunished
Princeton N. Lyman and Stephen B. Wittels

The United States' commitment to helping treat HIV patients is limiting Washington's leverage over recipient countries and undermining other development goals.

To the Editor:

In arguing that treating HIV/AIDS threatens U.S. foreign policy interests, Princeton Lyman and Stephen Wittels ("No Good Deed Goes Unpunished," July/August 2010) neglected medical data and repeated spurious arguments.

For example, they argue that the commitment to provide antiretroviral therapy "will become staggeringly large" as new infections outstrip deaths. This overlooks evidence that treating HIV/AIDS prevents new cases, because antiretroviral therapy reduces the infectiousness of the affected patients. In fact, thanks to antitretrovirals, the World Health Organization has forecast dramatic reductions in new infections. The alternative of education-based prevention programs, research suggests, fails to change most people's behavior.

The authors also claim that HIV/AIDS interventions divert funds from other public health programs, but as the researchers Alexander Irwin, Joyce Millen, and Dorothy Fallows have shown in their book Global AIDS: Myths and Facts, HIV/AIDS programs have used new funds rather than displacing existing ones. And these programs have provided spillover benefits -- training new health-care workers and building primary-care infrastructure. The hospitals and health-care workers that antiretroviral programs have funded are now treating a multitude of other diseases; yet the rhetoric of HIV/AIDS competition is now closing general hospital doors in Uganda and turning a chronic disease into a death sentence as patients are being cut off from care. Although transferring funds from disease-targeted programs to general health systems sounds reasonable in theory, in years past, Zambia's tuberculosis program collapsed after money was shifted to vague conferences and international consultant programs with no measurable outcomes; the same is now happening with its HIV/AIDS program.

The vast majority of available evidence shows that not treating HIV/AIDS is a greater threat to U.S. interests than maintaining the cost-effective provision of antiretrovirals.

SANJAY BASU
Department of Medicine, University of California, San Francisco

DAVID STUCKLER
Department of Sociology, University of Oxford

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