HIV / AIDS

The human immunodeficiency virus  (HIV) infects cells of the human immune system, destroying or impairing their function. In the early stages of infection, the person has no symptoms. However, as the infection progresses, the immune system becomes weaker, and the person becomes more susceptible to opportunistic infections such as Kaposi’s sarcoma or tuberculosis (TB). As many as 13% of new TB cases are amongst people living with HIV (WHO factsheet 2011).

The most advanced stage of HIV infection is called acquired immunodeficiency syndrome (AIDS). It can take 10-15 years for an HIV-infected person to develop AIDS; antiretroviral drugs can slow down the process even further.

HIV is transmitted through unprotected sexual intercourse, transfusion of contaminated blood, sharing of contaminated needles, and between a mother and her infant during pregnancy, childbirth and breastfeeding.1

According to estimates by WHO and UNAIDS, 34.2 million people were living with HIV at the end of 2011. That same year, some 2.5 million people became newly infected, and 1.5 million died of AIDS-related causes, including 230,000 children. More than two-thirds of HIV infections are in sub-Saharan Africa.2

Cost-Effectiveness

Though there is no known cure for HIV, antiretroviral treatment can substantially increase the length of life of someone with the virus. Standard antiretroviral therapy (ART) consists of the use of at least three antiretroviral drugs to suppress the HIV virus and stop the progression of HIV disease.

There are also various methods of reducing the rate of transmission of HIV, such as education about methods of prevention both to the general public and to specific groups such as sex workers - and distributing and promoting condom use.

We have been unable to find estimates of cost-effectiveness from the websites of charities that focus on HIV/AIDS. The DCP2 and WHO-CHOICE cost-effectiveness estimates are as follows:

In other words, according to these reports, it would cost $1000 to extend one HIV-sufferer's life for two years through antiretroviral therapy, preventing about 2 DALYs.3 But the same $1000 could extend people's lives by a total of about 950 years if spent on preventing the spread of the disease through mass media HIV/AIDS education, thereby preventing about 800 DALYs.4

The cost-effectiveness estimate for mass media education from WHO-CHOICE is the most striking that we have come across. We are unsure how much confidence to place in the figure: it seems independently plausible that mass media education could be an extremely cost-effective intervention; however, there is at least some countervailing evidence.5 Peer support education for high risk groups is also extremely impressive, but it too should be treated as only a rough estimate.

Other Information

Side effects

Positive side-effects of treatment and prevention of HIV/AIDS include:

• A decrease in the incidence and transmission of other diseases, such as TB.
• Prevention strategies for HIV/AIDS can also help to prevent other sexually transmitted diseases.
• Reducing the prevalence of HIV/AIDS has economic benefits.

Conclusion

Education appears to be the most effective way to reduce the number of people who will die from HIV/AIDS. Though we can't place great confidence in the WHO-CHOICE figures, if they are even correct to within an order of magnitude then peer education programmes for sex workers and, especially, mass media education, are hugely cost-effective.

Unfortunately, we have been unable so far to find charities that focus on, or dedicate a significant amount of their resources to, mass media education or education of high-risk groups and so we do not have any recommended charities for HIV/AIDS.