The New York Times made a good case the other day that AIDS aid may be taking funding and resources away from fighting simpler, more easily treated diseases like diarrhea and pneumonia. Although as a nation, the US spends close to $750 million a year on fighting AIDS in developing countries, AIDS accounts for a smaller percentage of childhood deaths than other diseases, like diarrhea. So the question is – if we are to spend the money we have saving as many lives as possible, is AIDS prevention and treatment really the best route to go? If not, is it actually harmful to spend so much on AIDS-related causes?

Jeffrey Sachs takes the view that we should not stop spending money on AIDS, but that the world (re: other countries) should simply dedicate more resources to maternal health in general:

[Sachs] rejected what he called the wrong-headed idea that “we need to make a terrible and tragic choice between AIDS or pneumonia.” The United States has invested heavily in the fight against AIDS, and other wealthy nations should pick up more of the cost of other global health priorities, he says.

“Rather than tearing down what’s working, we should continue to invest in what’s needed,” he said.

Sure, this would make sense if we had unlimited resources. Governments allocating funds to international aid do not have unlimited resources. This is why social scientists carefully study the outcomes of development programs – not only to see what works, but to see what works the best, so we can invest money in programs that provide the most bang for our buck. I’m failing to see how some decisions don’t need to be made here.

The article also profiles a woman who was immediately counseled by an aid organization to get tested for AIDS, but didn’t know to give her son oral rehydration salts as soon as he started showing signs of diarrhea. I see two needs here: the first is for distribution channels for oral rehydration salts, which sound cheap and small (the doctor quoted in the story says “everyone should have O.R.S. at home like we have Band-Aids”), and second is for knowledge of basic childcare (which makes me think of Geoffrey Canada’s Baby College, a topic for another post).

When is there enough evidence to change the status quo? In the ’80s, the U.S. government dedicated only $1 million to the CDC to research a cure for AIDS. At some point between then and now, AIDS turned into the “sexy” health cause – supported by celebrities and abandoned at a developed country’s peril. AIDS is a bigger threat to public health than diarrhea, which (as far as I know) is not contagious. However, waterborne diseases are a bigger killer than AIDS, and why not go after low-hanging fruit, especially when it doesn’t have to mean cutting off all funding to AIDS? Are we experiencing decreasing returns to AIDS aid, and should we channel that surplus to something that may be simple, but may have a larger effect on child and maternal mortality rates?