The discovery of a near-perfect way to halt sexual transmission of the AIDS virus has the potential to change the way international agencies and nations cope with the epidemic. But that can only happen if troubling issues of cost and practicality can be surmounted.
The study involved more than 1,700 couples in nine countries, the vast majority of them heterosexuals. One member had the virus that causes AIDS; the other did not. It demonstrated conclusively that if infected partners are treated with a cocktail of drugs immediately — instead of waiting for their immune systems to deteriorate — the risk of transmitting the virus to the uninfected partner drops by 96 percent. The only reported health benefit of early treatment for the infected partner was a reduced risk of tuberculosis spreading beyond the lungs.
Infected partners would have to start early on a lifetime of taking drugs mostly for altruistic reasons — to avoid infecting their partners. Further research may document greater health benefits. It seems likely that earlier treatment that keeps immune systems strong should further slow the progression of the virus to full-fledged AIDS and ward off other devastating co-infections.
International organizations don’t have enough money to treat all those who qualify for drug therapy under current guidelines. They will be hard-pressed to find additional money to treat millions more people to slow the spread of the virus. With most industrialized economies still lagging, there is little appetite for increasing aid.
A strong moral case can be made for protecting millions more people from infection, but there may be an economic case as well. We need valid, well-documented estimates as to whether a big investment in prevention now might pay for itself in the long run by greatly reducing the number of sick people who have to be cared for.