Health Care Issues

Decline In AIDS Deaths May Prompt More Cases

Fewer Americans died of AIDS in the first half of 1997 than in the same period of 1996. The 44 percent decline in deaths was mainly due to the use of life-prolonging drugs called protease inhibitors.

However the availability of such drugs is likely to cause the number of HIV infections to rise rather than fall say the authors of a 1993 book, "Private Choices and Public Health: The AIDS Epidemic in an Economic Perspective."

The authors, an economist and a federal judge associated with the University of Chicago, point out that as a sexually transmitted disease AIDS is totally avoidable, and people will rationally change their behavior in response to changes in the perceived risk.

  • That is because the more treatable a disease is, the smaller is the benefit to the individual of behavioral changes that reduce the risk of becoming infected.

  • For example, after the introduction of penicillin offered a complete cure for syphilis, there was a sharp rise in the number of people with the disease.

  • Because penicillin did not prevent syphilis but only made the consequences less serious, there was more high-risk sex.

Similarly, due to changes in behavior among high-risk groups, the AIDS epidemic had peaked and was declining before there was any effective treatment available.

  • The number of new AIDS cases peaked in 1992 and dropped by almost 30 percent by 1995, before protease inhibitors were in wide use.

  • During the same period the fraction of new cases among women, a lower-risk group, rose by almost one-half, though still to a level far below that of men.

  • And the total number of people with AIDS was higher at the end of 1996 than at the beginning.

Thus the economists contend the benefits of government investment in research for an AIDS cure may be largely offset by the costs of increased risky behavior encouraged by the cure.

Source: Thomas J. Philipson (University of Chicago) and Richard A. Posner (chief judge, Seventh U.S. Circuit Court of Appeals and University of Chicago Law School), "Optimism About AIDS is Premature," Wall Street Journal, February 4, 1998.

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