Penny stupid and pound moronic

A couple of years ago, when I blogged from the International AIDS Conference in Mexico City, I reported hearing a lot of optimism, or at least hope (which I didn't really share), or at least insistence on the necessity, of meeting the the goal of universal access to HIV treatment by 2010. This goal was accepted by the world community (if there is such a thing), and at one time seemed feasible because the drug companies had accepted -- or had forced upon them, more accurately -- licensing agreements which made standard antiretroviral packages available in resource poor countries at low cost, and in middle-resource countries such as Mexico at affordable prices. The U.S. and other wealthy countries had pledged to provide enough money to make it happen -- which is in the tens of billions of dollars annually, a trivial sum compared to the cost of war and corporate welfare. Infrastructure in the poor countries was building and the personnel were trained.

But we have failed. The donor countries did not come up with enough cash and the rate of new infections is now running ahead of the rate at which people are offered treatment. We're losing the AIDS war.

Last night Julio Montaner, president of the International AIDS Society, told us why this isn't just a moral failure. It is a profound failure of wisdom. It turns out -- although we weren't 100% sure of this before -- that when people are successfully treated and have undetectable viral loads, they are far less infectious -- perhaps not infectious at all. That doesn't mean you should go out and practice risky behaviors. You don't know, at any time, if you really do have undetectable viral load. Not everybody is completely adherent to drug regimens, and resistance can develop.

But on a population level, Dr. Montaner has shown that expanding treatment can greatly reduce HIV incidence. (As you will recall from a couple of weeks ago, that's the rate of new infections.) The result is that if you invest enough, you can catch up to the epidemic and cap it like a top-killed oil gusher. In the end, obviously, you will save a lot of money as well as human lives and you'll have a lot fewer orphans. If you don't do enough, the epidemic will start running away from you, as it is doing now, and you will never be able to catch up.

So which choice is the world making?