Class #28: Economics of HIV Testing
Prof. Wolaver

Neoclassical analysis
Assumptions of the model

•rational thought always
•purely self interested
•no market power/ differences in bargaining power
•we have perfect information (how might that affect decisions)
Testing:Costs:
If positive and status becomes known, will affect social standing

Going to get tested may be a signal that you have a higher probability of having HIV, if others see you being tested, again, stigma may enter in

Benefits: May be able to prevent transmission to children, others
(Assuming that altruism matters, in strict, self-interested model, this won’t come into play)

May be able to get treatment to extend life

Feminist critique of the testing
Treatment, what treatment?–> what good does getting tested do if can’t afford treatment
Stigma issue in cost side will be big
People may not have proper information about the disease, tests,
Some may think you can get it from giving blood, may be other myths

Taking the drug to prevent MTCT

Costs:
Price of drug to individual: compared to other regimens, less costly
Side effects

Benefits:
Reduction in transmission of virus from mother to child
may prolong life

But, if breast feed, can transmit postnatally
Woman said she wasn’t told about risks stigma if don’t

Feminist economist

Think about what are the assumptions underlying the model
If don’t have $ for drugs, why bother getting tested?

Women rely on others for financial and other types of support, signaling that a woman is HIV +
Also, if save the child, but mother dies, still not optimal (AIDS orphans)

No perfect information, how can women be expected to evaluate the relative risks? Doctors aren’t even sure

From society’s point of view

If could reduce transmission to children, still have to care for orphans

Not Breast feeding

Costs

stigma
b/c associated w/ West, really was exploitation to try to sell formula
if no potable water-> much greater risks (2 to 5 times) of death for child before age 5
formula is expensive: $1425.00 for 6 months of feeding in MIDDLE Class infants w/ good hygiene (includes extra health care costs)
When you add this, the $4 for nevaripine

Benefits

reduce transmission of HIV-> by 5 (recent study) to 15%? (no perfect information, study results may be biased downward b/c of noncompliance on formula feeding arm)

Statistics from “breast feeding and HIV: What choices does a mother really have?” in Nutrition Today, 1999 Elizabeth Hormann

with??? treatment?? Without?
20 infants will acquire HIV in utero or at birth - should breast feed them, b/c need all immunological health benefits of breast feeding
15 +? will acquire through breast feeding: these are the ones we should bottle feed65 could be breastfed safely, b/c won’t acquire AIDS for unknown reasons

Decision

Provide or not????
What do we need for it to work?

Need women to come in and get tested
Need them to find results
Need them to get the treatment (have money)
Need them to NOT breast feed

Lack of information; may suspect the public health clinics if a stigmatized (tie to Messer’s talk)

Outside information:

Breast feeding limits (somewhat) fertility; could help prevent another child being born HIV+
Mixed feeding seems to be the worst possible choice (may introduce physical damage to gastrointestinal tract)
Could see some mothers trying to bottle feed, but then in public places breast feeding
Why it’s so hard to know w/ certainty risks associated with transmission:
There is a test that distinguishes mother’s antibodies from child’s- in other words, a normal positive HIV antibody test in a child might not mean that the child is infected. Poor countries can’t afford this test.
Risks of breast feeding differ depending on when mother is infected (worse if the mother has higher viral loads, and worse if she becomes infected after birth but while breast feeding)
So, until the child is weaned, or until about 18 months, can’t really tested and know with certainty when or whether the child is infected.
We don’t know whether the transmission rate through breastmilk is different after anti retroviral treatment during labor

OTHER OPTIONS:
HIV- wet nurses

NESTLE:
International code prevents direct marketing of formula to mothers, and definitely no free samples through clinics–> implies a medical endorsement of the product.
WHO international recommendations for NON HIV+ mothers is no formula until at least 6 months.