Until recently, antiretroviral (ARV) therapy could not be considered as a possible way to prevent sexual transmission because the available drugs for treating HIV/AIDS had little impact on infectivity. The 1997 discovery that protease inhibitors and triple-drug therapy suppress HIV below the level of the most sensitive blood tests to detect it has raised hopes that these drugs might prevent the spread of HIV, in addition to greatly extending the life of the patient. Even if this proves true, however, policymakers deciding whether to provide public subsidies will need to consider that the $10,000 to $20,000 cost of treating a single patient would prevent many more cases if spent on focused prevention in high-risk groups. Furthermore, we saw in chapter 1 that even without the expense of antiretroviral therapy, current expenditure for treating an AIDS patient would buy a year of primary school for ten students in most developing countries. In the poorest countries, the much higher cost of antiretroviral therapy would buy a year of primary school for 400 students. For this reason, even if the cost of antiretroviral therapy is shown to reduce the infectivity of sexual contacts, and even if the cost falls substantially, decisionmakers will still want to consider very carefully before initiating such subsidies.
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