From the Advisory Council

By Maurice Tempelsman

Today, more than ever, we as human beings can do something about the problems around us. The cumulative accomplishments of humanity challenge us to renounce blind submission and resignation. With humility and respect for the forces of life and nature, we can shape and help guide our destiny.

At a time of subdued expectations of emerging markets elsewhere, the rapidly modernizing nations of Africa hold the potential for exceptional economic performance over the next decade and beyond. These bright prospects, however, are threatened by the scourge of AIDS. Economists have predicted that in some nations that have been especially hard hit by AIDS, the epidemic may slow or even reverse hard-won gains in human and economic development.

The confluence of booming economies and a highly virulent agent such as HIV may prove disastrous for Africa. Although economic growth generally improves living standards, the urbanization and flow of goods and people that accompany industrial expansion can serve as a conduit for the spread of HIV. In much of sub–Saharan Africa, per capita spending on health averages less than $100 a year. A recent World Bank report notes that the average cost of treating opportunistic infections that respond to inexpensive treatments and providing the most basic palliative care to AIDS patients was around $300 per year in sub-Saharan Africa and $1,000 per year in Thailand—well above the average per capita health budget for either place. If one factors in opportunistic infections that are more costly to treat, the average cost jumps to $490 and $1,600 per patient per year, respectively.

Who pays this bill? In most developing countries, governments necessarily subsidize a significant proportion of health care costs, including those for AIDS care. As infection rates rise and more people become ill, AIDS patients may overwhelm limited public facilities and resources, forcing governments into a severe bind.

Governments may seek to raise taxes, potentially choking off economic growth, or they may curtail medical and social services, leaving those affected to fend for themselves. Because it predominantly strikes working-age adults, AIDS simultaneously raises labor costs and slows consumption, both of which undermine a growing prosperity and associated improvements in standards of living.

This appeal to economic considerations rather than human compassion may seem insensitive, but looking at the epidemic through a pragmatic lens may help decision makers in the United States and abroad to seek out the necessary resources. By taking a portion of the roughly $2 billion in annual profits earned from African affiliates and investing it in AIDS prevention programs and vaccine research, U.S. corporations, for example, could change the epidemic’s course and extend Africa’s current economic progress. Such investment would pay dividends not only in Africa, but also in Asia, where the financial stakes may be even higher and the epidemic has yet to unleash its full fury. Rarely are corporate leaders given such an opportunity to harmonize moral imperatives with the corporate bottom line.

The situation calls for action, not despair. While researchers still have much to learn about HIV, the scarcity of resources to cover the epidemic’s costs may present a challenge even greater than scarcity of scientific knowledge about this disease. With sufficient international attention and commitment, both challenges can be met.

—Maurice Tempelsman
Chair of the Harvard AIDS Institute International Advisory Council