Freakonomics: ARVs vs Prevention

They say prevention is better than cure. But is it cheaper? 

When looking at HIV/AIDs in South Africa (particularly in Kwa-Zulu Natal) the statistics are overwhelming. Even after years of “ABC’s” (Abstain, Be Faithful, Condomise), KZN HIV stats are some of the highest in the world. In particular, Mpumuza, where iThemba focuses, is among the highest in South Africa. It is one of the two districts mentioned by the KZN premier in a recent UNAIDS meeting: “Despite these gains, KwaZulu Natal remains South Africa’s most affected province with an antenatal HIV prevalence of more than 40% in two of its districts and more than 1.6 million people living with HIV in 2011.” I have heard even higher stats than these for this year.

The government is doing it’s best to keep up with the demand for ARV’s, but when people are scattered around in rural areas, it is difficult to make sure that everyone who needs access to this vital medication can get it. And while I think we should focus all we can on making sure people have access to ARV’s, (and other relief measures related to HIV like orphanages for babies who lose their parents) I think we also need to double the amount of effort and funds that are donated towards prevention. 

Since David has been reading Freakaoomics (every time we go to the bookstore he reads another chapter) I decided to see if I could work out the cost of keeping someone on ARVs for life, or making a sustained effort at preventing them from getting AIDS in the first place.

This is tricky, because you can easily measure the cost of producing a medication, and it’s also pretty easy to work out statistics for how effective it is. How do you measure prevention techniques? 

Firstly, while mother to child transmission still happens, treatment can (and has) decreased that tremendously. So most transmissions come through unprotected sex. The easiest thing to measure prevention would be to count how many condoms you had out (except, handing out condoms just makes sex without a condom more valued, and women can get lots more money risking their lives to have sex without one. whoops.There’s some freakonomics for you.)

The harder thing is to try and figure out why there is so much unprotected sex in KZN and figure out what can be done to change that situation. That’s really difficult and I don’t actually know the reason why. I’m guessing a lot has to do with poverty, lack of education, denial about infection rates, men having multiple partners, high rate of teenage sexual activity, a rise in “sugar daddies” (who give things to young girls for sexual favors) and other forms of abuse, misunderstandings about how HIV can be spread etc.

iThemba’s response to all of this is to put role models in the community who not only teach the kids the dangers of unprotected sex, but also live out a life-style of abstinence until marriage– showing the kids it really is possible. As a Christian organization, we believe that God’s plan for sexual faithfulness in marriage is the way life works best. Along with that, we want to continue to pour out love on those infected with HIV, whether through their own choices, or the choices of others— we don’t want our teaching on sexual morality to exclude or shame other people, since that’s really not at all what Jesus was about!

iThemba staff build relationships with kids through school classes, after school sports clubs, Life Groups (after school groups that meet in homes and play games as well as study the Bible), Saturday Kids and Teens Clubs, camps and holiday programmes. The many after school recreational programmes also give the kids and teens a chance to be safe (away from abusive situations where they could be taken advantage of) increase their self-esteem, encourage them to envision a future for themselves, and decrease the chances that just because they’re bored or looking for love they’ll engage in unprotected sex. iThemba staff believe that by introducing kids and teens to Jesus, they’ll have a the power to resist peer-pressure and do things the way Jesus would. This relational approach I believe is more effective than just teaching kids about HIV in school.

In a study of at-risk teens from the University of Michigan, the researchers found that at-risk teens who had just one person in their lives that they could talk to about the things that troubled them were able to overcome the challenging environment around them and were more successful in life. iThemba staff aim to be that one person for the kids in Sweetwaters.

But even if we followed these kids for 10 years, how would we know that it’s iThemba programmes and staff that are making a difference in these kids and its not just that they naturally had the self-esteem and self-awareness to do all they could to keep from getting HIV?

We can’t really. I mean, unless someone wants to make us a PhD case study.

But here’s what my grand mathematics have figured: 

One person taking ARV’s for 30 years at the current cost would be about R30 thousand ($3 000)(our government and others are helping to keep this cost down).

Keeping an iThemba mentor in the community full-time 5 days a week for ten years would be around R20 thousand ($2 000) per child.  (This is assuming the iThemba mentor is only interacting with 50 children).

So I say, why not bet your money that the iThemba mentor really is making a difference and support them? It’s a better investment.  

*Where I got my numbers from: The current ARV pill is R93 per month. I don’t know what an iThemba mentor’s yearly salary is, but I gave them one that’s above minimum wage, but less than David (who teaches at a private Christian school). It’s enough to live decently in Sweetwaters. Then I divided that by 50 children. And yes… I struggle at math, so if you work this out yourself and see I made a mistake.. I probably did! 🙂 Feel free to correct me! 😉