Who's Counting: Costs For AIDS in Africa
August 1, 2000 -- “The death of one man is a tragedy. The death of a million men — that is statistics.” — Joseph Stalin.
The AIDS crisis in southern Africa is killing millions of people and, we are told, will lower the average life span in some countries there to the mid-30s, a level not seen since the days before Louis Pasteur determined the cause behind most infectious diseases in the mid-1800s.
Twenty percent of South Africa’s population is said to be HIV-positive, while one-third of Botswana’s citizens are believed infected.
This latter fraction, were it to hold in this country, would translate into 90 million infected Americans. That would include the residents of New York, Philadelphia, Atlanta, Miami, Chicago, Minneapolis, Houston, Denver, San Francisco, and Los Angeles with many millions more to spare — all living with a death sentence. Similar infection percentages hold for Swaziland, Namibia, and Zimbabwe.
One should, of course, question the numbers and percentages involved.
Uncertain Numbers, Certain Need
Figures on HIV-infection are notoriously inaccurate even in this country, no doubt more so in underdeveloped countries. Estimates of the number of people infected with the AIDS virus worldwide usually range between 30 million and 50 million, with some estimates outside this wide range.
Biased sampling, political motives, self-reporting of disease states, and other statistical problems undoubtedly exist. Still, whatever they are, the HIV figures for sub-Saharan Africa are certainly horrendous enough to more than justify the chintzy one billion dollar loan from the U.S. export-import bank announced on July 19.
Anyone who has written about risk assessment and cost-benefit analyses, as I have, has frequently heard from people who utter such twaddle as, “No matter what it costs, if it saves one life it’s worth it.” Where are these people now when a relatively small investment by the West could literally be a life-saver, millions of times over? And what do the presidential candidates who profess to be so ardently religious say about the millions who are dying?
A little more than 50 years ago the United States spent what would be the equivalent today of almost $100 billion on the Marshall Plan to help Europe recover after World War II. It was a magnanimous, humanitarian gesture that, by insuring a prosperous and vibrant Europe, also helped us economically.
There doesn’t seem to be the economic incentive or political will to do anything comparable for southern Africa today. Nevertheless, can we not spend roughly 5 percent of that total, say $5 billion (as a grant and not a loan), to help sub-Saharan Africa deal with the AIDS calamity?
Cost-Effective Approaches
The primary goal, of course, would be to drastically lower the HIV-infection rate. Public relations campaigns promoting the use of condoms, advertising the horrors of AIDS, and debunking belief in curses, witchcraft, and voodoo would be effective and relatively inexpensive. Such measures have worked in Uganda and other countries which have seen their new infection rates drop precipitously.
Also helpful would be promotion of male circumcision, which hinders transmission of the virus, and, perhaps, encouragement of abstinence, which hinders it even more. Better control over other sexually transmitted diseases is also essential.
AIDS drugs are much more costly than these measures, but even here there is a little room for maneuver. Knock-off drugs from Brazil and India might be used and American drug companies might come up with cheaper versions of their drugs.
South African President Mbeki’s flirtation with the discredited notion that HIV is not the cause of AIDS is clearly wrong-headed and irresponsible, but he’s right that a much less costly approach than the drug cocktails used in this country must be found. The analogue of a small transistor radio is what’s needed, not that of a huge home entertainment center.
We can, of course, pin our hopes on a scientific breakthrough and a vaccine or even a cure, but real breakthroughs are, by their very nature, impossible to predict. Imagine someone in 1890 forecasting that in about 15 years we would have a special relativity theory. If the theory’s advent could be predicted, the theory would, in a sense, already exist.
Even without breakthroughs we should anticipate some improvements in AIDS treatment and some changes in behavior. Since the age-specific death rates for people in their 20s and 30s are likely to improve, the decline in the average life span will eventually be reversed. This does not help, and very likely nothing will help, the estimated 20 to 35 million people already infected in sub-Saharan Africa, roughly 70 percent of all the HIV-infected people in the world. Nor does it help those countries where more than a third of the teenagers are infected and likely to die.
Money Stretched Thin
We should not kid ourselves about what the $1 billion loan or even a $5 billion grant will do for those already infected. One billion dollars, even if it went not for public health care measures, but exclusively towards those infected, would result in only $30 going to each person infected. By contrast, the regimen of AIDS drugs offered in the U.S. costs about $12,000 per patient annually!
AIDS has overtaken malaria as the number one killer in Africa but, unlike malaria, it threatens to lead to widespread economic collapse. Five billion dollars earmarked for AIDS programs in sub-Saharan Africa is not an unreasonable expenditure. It is what a jury initially awarded last year to six people severely burned in a GM car, it’s considerably less than what was spent on the military operation in Kosovo, and, as I said, it’s only 5 percent of what was spent on the Marshall Plan
On the other hand, of course, in this summer of our content we could just ignore AIDS in Africa.
Professor of mathematics at Temple University, John Allen Paulos is the author of several bestselling books, including Innumeracy and A Mathematician Reads the Newspaper. His “Who’s Counting?” column on ABCNEWS.com appears on the first day of every month.