Dying to get sick

In a new report on HIV and corruption in South Africa, A Lethal Cocktail (pdf, 119 pages), Transparency International point the finger once again at South African President Thabo Mbeki. His dithering over HIV has, they say, created a climate of secrecy on the one hand and impunity on the other; both of these allow corruption to flourish. Nothing new there, then.

One thing that was new, at least to me, was the report’s claim that poorer South Africans are deliberately exacerbating their HIV infection because they need money more than they need good health. It works in two ways. Firstly, people whose who have fewer than 200 protective T-cells per milliliter of blood (in the jargon, people with CD4 counts below 200) are entitled to free antiretroviral treatment; those with higher CD4 counts are not. So some poorer people with low counts are collecting the drugs and then selling them off to people who want them, but aren’t quite sick enough to get them for free.

Secondly, people who get drugs for themselves don’t always take them properly, because the drugs do such a good job of making them better. And if they get a lot better, they might no longer qualify for disability benefits that doctors can recommend for patients who are considered too sick to work normally. So they take their drugs intermittently, but not enough to restore them to good health.

This is bad for them, obviously, because they are denying themselves good health. But it is bad for everyone else, too. Intermittent use of antiretrovirals increases the likelihood that an infected person will pass on the disease (because the amount of virus in the blood bounces back up when someone who was on drugs stops taking them). And it increases the chance that HIV will mutate into forms that are no longer suppressed by drugs.

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This post was published on 29/11/07 in Money and AIDS, Science.

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