The Problem

(William Easterly "White Man's Burden")

"A patient who is already HIV-positive is a highly visible target for help-- a lot more visible than someone who is going to get infected in the future but doesn't yet know it. The rich-country politician and aid agencies get more PR credit for saving the lives of sick patients, even is the interest of the poor would call for saving them from getting sick in the first place. This again confirms the prediction that aid agencies skew their efforts toward visible outcomes, even when those outcomes have a lower payoff than less visible interventions."

A 2004 article in the Journal of the American Medical Association, while generally positive about treatment in developing countries, sounded some concerns:

"Finally, how will the tens of thousands of health care professionals required for global implementation of HIV care strategies be trained, motivated, supervised, resourced, and adequately reimbursed to ensure the level of care required for this complex disease? To scale up antiretroviral therapy for HIV without ensuring infrastructure, including trained practitioners, a sage and reliable drug delivery system, and simple but effective models of continuity of care, would be a disaster, leading to ineffective treatment and rapid development of resistance."

"Spending money on a mostly futile attempt to save all the lives of this generation of AIDS victims will take money away from saving the lives of the next generation, perpetuating the tragedy."

"The West largely ignored AIDS when it was building up to a huge humanitarian crisis, only to focus now on an expensive attempt at treatment that neglects the prevention so critical to stop the disaster from getting even worse."

(William Easterly "White Man's Burden")