Treatment scale-up: economic and social arguments
Economic and social analyses provide a clear rationale for emergency action on treatment scale-up. While a number of early studies suggested that the use of antiretroviral drugs was not cost-effective in poor countries, more recent analyses have indicated the contrary (6). The World Health Report 2002 suggested that some types of treatment would be cost-effective even in resource-poor settings (7). Since then, prices of the drugs have fallen by more than 50%. Meanwhile, protocols developed for the 3 by 5 initiative should help make them even more cost-effective, particularly in countries where people with opportunistic infections are hospitalized. The use of antiretrovirals should reduce these infections for several years at least. This should in turn help cut health costs specific to HIV/AIDS, as has been documented in Brazil (8).
As Chapter 1 showed, many early studies seriously underestimated the cumulative economic and social damage of HIV/AIDS in high-burden countries. Antiretroviral treatment can help stem the loss of human capital and productivity if it restores the health of millions of people and enables them to earn an income, raise their children and contribute to society. Under Brazil's universal access antiretroviral treatment programme, the average survival time of people with AIDS seeking care at government facilities has risen from less than six months to at least five years (9). Patients' quality of life has also improved significantly: they go on working, sustaining their families, educating their children and interacting with their friends.