The most effective way to control the AIDS pandemic in hard-hit South Africa would be to concentrate the allocation of scarce antiretroviral drugs in urban areas. This, however, would not be the most ethical approach, according to an innovative new study from the UCLA AIDS Institute.
The article is scheduled to be published in the Proceedings of the National Academy of Sciences online Early Edition (http://www.pnas.org/cgi/doi/10.1073/pnas.0609689103) during the week of Sept. 11-15.
Using data from the KwaZulu-Natal province for their parameters, researchers from UCLA and the University of California, San Francisco, devised a mathematical model to predict the impact of drug allocation strategies that the South African government is implementing to treat 500,000 people by 2008. These data included birth rates, natural death rates and death rates stemming from AIDS.
They looked at three drug allocation strategies: one that would allocate antiretroviral drugs only to the city of Durban and two making them available in both urban and rural areas.
Of those, the Durban-only strategy would be the most effective in preventing new infections, reducing them by up to 46 percent -- amounting to preventing an additional 15,000 infections by 2008 -- compared with the two strategies that would include both urban and rural areas. The strategy also would avert the greatest number of deaths from AIDS and generate the least amount of drug resistance.
But major problems would emerge with that approach, said Sally Blower, professor at the Semel Institute for Neuroscience and Human Behavior at UCLA and senior author of the study. Most important, this approach is against basic ethical principles guiding treatment equity and would lead to more urban/rural healthcare disparities than already exist.