Treatment versus prevention in the fight against HIV/AIDS and the problem of identified versus statistical lives

Abstract

For years, discussions about the best way to combat the HIV/AIDS pandemic have pitted proponents of scaling up antiretroviral treatment for people already suffering from AIDS against other writers, who advocate for a focus on more cost-effective prevention measures. In an important recent article, Dan Brock and Daniel Wikler (2009) frame the underlying moral issue as a debate about whether, given long-term budget constraints, there are any moral grounds to privilege the saving of identified lives through antiretroviral treatment, even if concentrating on preventive methods could save more (statistical) lives overall. In this chapter, I critically examine Brock and Wikler’s contention that since all human lives have equal worth, there can be no sound moral basis for giving any priority to the saving of identified over statistical lives, all else equal. In so doing, I develop a novel account of how the choice between “treatment” and “prevention” in population-level health policy intersects the problem of identified versus statistical lives. The chapter concludes with a postscript on “treatment-as-prevention,” a new avenue of AIDS research that stresses the preventive benefits of early antiretroviral treatment. I argue that, while scientifically promising, treatment-as-prevention does not transcend the ethical dichotomy between treatment and prevention explored in this chapter.