Questions on Art & HIV
prevention in Botswana
Mead Over
Senior Fellow
Center for Global Development
June 6, 2007
Direct benefits of anti-retroviral
(ART) Treatment
-
-
Health benefits: Life saved,
quality of life. Fewer orphans.
Economic benefits: labor force
participation, children going back
to school, less child labor
Fraction participating in labor force
.7
.8
.9
Labor force participation before and
after treatment in Kenya
.6
Has Botswana
documented
similar benefits?
-8
0
8
16
24
Weeks on ARVs
32
40
Source: Goldstein, Graff Zivin and Thirumurthy 2005
48
56
The objective: An “AIDS Transition”
„
„
„
Death rate from AIDS permanently
reduced
Rate of new infections permanently
reduced even lower
The number of people living with
AIDS would then eventually decline
Classic analysis of the
demographic transition
Rate
per
1000
people
Rate of
population growth
Births
Deaths
Time
Source: Over (2004a)
“Population
explosion”
A successful “AIDS Transition”
Rate
per
1000
people
Rate of growth of people
living with HIV/AIDS
New
infections
AIDS
Deaths
Time
Source: Over (2004a)
“Explosion of
ART patients”
Botswana: Fall in death rate &
explosion of people on ART
Fall in death
rate
Explosion of
people on
ART
Source: WHO (2007)
As patients move to 2nd line ART,
fiscal burden grows more rapidly
than the number of patients
Millions
Total Cost of Public ART (NAPHA)
$500
$450
Botswana
is
$400
now about
here $350
In Thailand
expenditures
will triple
before they
level off
$300
$250
$200
$150
$100
$50
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
$0
Cost of Public ART_1 line_asy
Cost of Public ART_1 line_sym
Cost of Public ART_2 line_asy
Cost of Public ART_2 line_sym
Source: Revenga et al (2006)
Transition might fail because
treatment stops working …
Rate
per
1000
people
New
infections
AIDS
Deaths
Rate of growth of people
living with HIV/AIDS
Time
Source: Over (2004a)
“Boom” of ART
patients
Botswana: How long will
patients survive on ART?
About 10%
of ART
patients die
each year
Source: WHO (2007)
… or because the rate of new
infections never declines.
Rate of growth of people
living with HIV/AIDS
Rate
per
1000
people
New
infections
AIDS
Deaths
Time
Source: Over (2004a)
“Explosion of
ART patients”
ART can affect HIV prevention
Biological
Effects which
might slow
Transmission
• Reduces viral
load
Effects which
might speed
Transmission
• Lengthens duration
• Selects for
resistance
Behavioral • Motivates testing • Reduces perceived
• Promotes
risk of unsafe
behavior
solidarity
Source: Over et al (2004b)
Suppose ART
increases HIV transmission
New
infections
Rate
per
1000
people
Rate of growth of people
living with HIV/AIDS
AIDS
Deaths
Time
Source: Over (2004a)
“Explosion of
ART patients”
Questions posed to Dr. Moeti
„
„
„
Does Botswana have a back-up plan
to pay for AIDS treatment in case aid
from outside is not enough?
In Botswana, has treatment success
reduced or increased risky behavior?
Has Botswana found a way to use
treatment as a tool for prevention?
References
„
„
„
„
„
„
Over, Mead. 2004a. Impact of the HIV/AIDS epidemic on the health sectors of
developing countries. In The macroeconomics of HIV/AIDS. Edited by Markus
Haacker. Washington, D.C.: International Monetary Fund.
Over, Mead et al., "Antiretroviral therapy and HIV prevention in India: modeling
costs and consequences of policy options," Sex Transm.Dis. 33 (10 Suppl): S145S152 (2006).
Thirumurthy, Harsha, Johsua Graff-Zivin, and Markus Goldstein, "The economic
impact of AIDS treatment on labor supply in western Kenya," NBER Working Paper
No.11871:47, December 2005 (2005).
Over, Mead. et al. 2004b. HIV/AIDS Prevention and Treatment in India: Modeling the
Costs and Consequences. Washington: World Bank.
Revenga, Ana et al. 2006. The economics of effective AIDS treatment: Evaluating
policy options for Thailand. Washington, DC: World Bank.
WHO, UNAIDS, and UNICEF. Towards Universal Access: Scaling up priority HIV/AIDS
interventions in the health sector, Progress Report, April 2007. 2007. Geneva,
Switzerland, World Health Organization. 6-8-2007.