Caring for patients with HIV and AIDS in middle income countries

BMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7055.440 (Published 24 August 1996) Cite this as: BMJ 1996;313:440
  1. Eric Van Praag,
  2. Joseph H Perriens
  1. Health planner, Office of HIV/AIDS and Sexually Transmitted Diseases, World Health Organisation, 1211 Geneva 27, Switzerland
  2. Clinical research specialist, Department of Policy, Strategy and Research, UNAIDS, 1211 Geneva 27, Switzerland

    Preventing transmission from mother to child is far more cost effective than treating symptomatic infection

    In countries with rapidly growing economies, such as Thailand, Brazil, Malaysia, and South Africa, public spending on health has increased both in relative and absolute terms.1 It is hardly surprising that in these expanding markets new expensive medical technologies are being promoted as well. While this offers promises for people living with HIV, the mere availability of these technologies poses the challenge of how to optimise their use. As in industrialised countries, the debate on new medical technology is often centred around the potential benefits for individual patients and ignores the societal and family consequences, the feasibility of equitable and widespread application, the conditions under which optimal efficacy may be obtained, and the budgetary constraints under which priorities need to be set.

    Antiretroviral therapy is a good example. In order to realise a sizeable benefit from the use of antiretroviral drugs, these drugs must be started early and used regularly for a long time. Simple as this may sound, it means that potential beneficiaries must be identified at a time when the drugs are still effective, not when the patient is terminally …

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