HIV cannot be tackled in isolation

BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7567.552 (Published 07 September 2006) Cite this as: BMJ 2006;333:552
  1. Peter A West, senior associate (paw11{at}york.ac.uk)
  1. York Health Economics Consortium, University of York, York YO10 5NH

    EDITOR—The news extra by Clark with much of the evidence on delivering health care for HIV in less developed countries highlights a key issue in all such countries.1 To raise one part of the country (one service, one sector such as education or health) to a much higher level is impossible without raising the whole economy.

    Health professionals, even if well paid, are unlikely to want to work in areas where their children cannot get a good education or where they cannot rely on an energy supply at work or at home. Road safety alone poses a major threat in many less developed countries, as well as crime and civil unrest.

    Faced with these additional “costs” of working in such countries, many will choose to go elsewhere, if only to more comfortable cities in the same part of the world. The developed world needs to come to terms with its failure to do enough to raise general standards of living, education, and public health and safety in less developed countries. Until that happens, pouring large amounts of money into single “vertical” disease programmes will not transform the health prospects of populations of less developed countries.


    • Competing interests York Health Economics Consortium is a contract research company owned by the University of York. It has a range of public and private sector clients but is not active in relevant research fields on HIV in the third world. PAW has worked extensively on the cost effectiveness of HIV prevention but is not doing so currently. Past research has been funded by the Overseas Development Institute and Department for International Development and non-governmental agencies in HIV prevention.


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