Surprising AIDS-treatment benefits, prevention strategy in epidemic regions of Africa

December 01, 2010

Two teams of researchers at UC San Diego and other U.S. and African universities and the World Bank have documented significant spillover benefits of a drug therapy to combat AIDS symptoms and a novel prevention strategy that focuses on girls in Sub-Saharan Africa, an area with two-thirds of the world's HIV infections.

A recently published paper in Public Economics documents a dramatic "Lazarus effect" in AIDS-affected households in rural Kenya when infirmed members received anti-retroviral therapy (ART). The study found that not only did the health of those treated improve, but the households also began to accumulate livestock and other assets and they increased their investments in the education of their children.

"Most successful AIDS relief initiatives have been lopsided in their focus on anti-retroviral therapy, but behavioral dimensions of the epidemic are equally significant," said Joshua Graff-Zivin, co-author of the study and associate professor of economics at UC San Diego's School of International Relations and Pacific Studies (IR/PS). "Anti-retroviral therapy may be achieving much more far-reaching impacts than just the medical benefits, and anti-retroviral therapy may help the continent escape a much broader set of behavioral poverty traps that would otherwise arise from stratospheric HIV-prevalence rates."

The study was supported by a partnership of the U.S. Agency for International Development. Graff-Zivin worked with Harsha Thirumurthy, assistant professor of health economics at the University of North Carolina, and Markus Goldstein, a senior economist at the World Bank. The team showed that when affected members of rural Kenyan households received the drug therapy, a range of household investment indicators suddenly improved. In addition, children's nutritional status went up and their school attendance increased more than 20 percent within six months after treatment was initiated for the adult patient.

"This Lazarus effect, whereby those who had expected a swift decline and death are granted a new lease on life by treatment, suggests that without effective anti-retroviral treatment, the epidemic may be having pervasive negative effects on people's willingness to think long-term and to invest for the future," Graff-Zivin said. "This study shows that effective treatment yields significant economic dividends such as improved capital investment. Based on our latest field research we also think anti-retroviral therapy enhances environmental stewardship and a host of other positive effects as households switch from a sense of hopelessness to planning for their long-term futures."

In a separate study conducted in the southern African nation of Malawi and recently published in Health Economics, researchers found that providing small monthly cash payments to girls significantly reduced sexual activity, teen pregnancy and marriage. New results from a series of working papers report that the prevalence of HIV and Herpes is also significantly reduced by the intervention. In order to continue receiving the money as part of the study, the girls were required to remain in school as part of a "conditional cash transfer" program.

Two dramatically positive results were measured:"This study was the first rigorously estimated evidence that a behavioral intervention may have meaningful effects on the trajectory of the HIV epidemic," said Craig McIntosh, a co-author of the study and associate professor of economics at IR/PS. "Similar programs in Mexico, Brazil and Nicaragua have demonstrated efficacy in improving school enrollment, learning or labor-market outcomes, but we suspected that the conditional-cash-transfer approach could also have a strong impact on the health of girls living in an epicenter of HIV infections."

The conditional-cash-transfer program virtually eliminated sexual relationships between teen-age girls and men over 25. "This is very important because this approach greatly reduces HIV transmission from an older demographic group to a younger one, which could lead to the epidemic burning itself out," McIntosh said. "This study shows how the lives of girls can be improved, vulnerable households can be protected, and spread of the HIV epidemic can be significantly slowed."
-end-
The study was supported by the Global Development Network and the Bill and Melinda Gates Foundation. The research team included McIntosh; Sarah Baird, an assistant professor of global health at George Washington University; Ephraim Chirwa, associate professor of economics at the University of Malawi, and Berk Özler, an economist with the World Bank.

University of California - San Diego

Related HIV Articles from Brightsurf:

BEAT-HIV Delaney collaboratory issues recommendations measuring persistent HIV reservoirs
Spearheaded by Wistar scientists, top worldwide HIV researchers from the BEAT-HIV Martin Delaney Collaboratory to Cure HIV-1 Infection by Combination Immunotherapy (BEAT-HIV Collaboratory) compiled the first comprehensive set of recommendations on how to best measure the size of persistent HIV reservoirs during cure-directed clinical studies.

The Lancet HIV: Study suggests a second patient has been cured of HIV
A study of the second HIV patient to undergo successful stem cell transplantation from donors with a HIV-resistant gene, finds that there was no active viral infection in the patient's blood 30 months after they stopped anti-retroviral therapy, according to a case report published in The Lancet HIV journal and presented at CROI (Conference on Retroviruses and Opportunistic Infections).

Children with HIV score below HIV-negative peers in cognitive, motor function tests
Children who acquired HIV in utero or during birth or breastfeeding did not perform as well as their peers who do not have HIV on tests measuring cognitive ability, motor function and attention, according to a report published online today in Clinical Infectious Diseases.

Efforts to end the HIV epidemic must not ignore people already living with HIV
Efforts to prevent new HIV transmissions in the US must be accompanied by addressing HIV-associated comorbidities to improve the health of people already living with HIV, NIH experts assert in the third of a series of JAMA commentaries.

The Lancet HIV: Severe anti-LGBT legislations associated with lower testing and awareness of HIV in African countries
This first systematic review to investigate HIV testing, treatment and viral suppression in men who have sex with men in Africa finds that among the most recent studies (conducted after 2011) only half of men have been tested for HIV in the past 12 months.

The Lancet HIV: Tenfold increase in number of adolescents on HIV treatment in South Africa since 2010, but many still untreated
A new study of more than 700,000 one to 19-year olds being treated for HIV infection suggests a ten-fold increase in the number of adolescents aged 15 to 19 receiving HIV treatment in South Africa, according to results published in The Lancet HIV journal.

Starting HIV treatment in ERs may be key to ending HIV spread worldwide
In a follow-up study conducted in South Africa, Johns Hopkins Medicine researchers say they have evidence that hospital emergency departments (EDs) worldwide may be key strategic settings for curbing the spread of HIV infections in hard-to-reach populations if the EDs jump-start treatment and case management as well as diagnosis of the disease.

NIH HIV experts prioritize research to achieve sustained ART-free HIV remission
Achieving sustained remission of HIV without life-long antiretroviral therapy (ART) is a top HIV research priority, according to a new commentary in JAMA by experts at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.

The Lancet HIV: PrEP implementation is associated with a rapid decline in new HIV infections
Study from Australia is the first to evaluate a population-level roll-out of pre-exposure prophylaxis (PrEP) in men who have sex with men.

Researchers date 'hibernating' HIV strains, advancing BC's leadership in HIV cure research
Researchers have developed a novel way for dating 'hibernating' HIV strains, in an advancement for HIV cure research.

Read More: HIV News and HIV Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.