<P>CULTURES Vol 1, Issue 2 ┬╗Page 63 a large majority of the people who have contracted HIV have done so through the normal routine of sexual in- tercourse, or sometimes owing to contaminated blood transfusions or inheritance at birth from an HIV+ mother. The treatment of the population that is HIV+ generates an economic liability, analogous to the liability of sov- ereign debt. Indeed, in some high-prevalence countries this liability may even exceed sovereign debt as con- ventionally conceived. Just as ?nance ministries need to ensure that debt can be managed within the means available to them, so they need to factor the continuing costs of treatment of HIV+ citizens into their calculations. In most cases, these costs are continuing to increase as the numbers beginning ART each year exceed the numbers who die, presenting a growing burden to the next generation. And this is also an issue for aid donors, who in many cas- es have met the lions share of the costs of treatment to date and need to consider the longer-term implications for their support. Once the duty of rescue is recognized as generating a debt burden, it becomes sensible to spend on prevention at least up to the point at which an extra dollar on prevention programs averts an extra dollar of debt. This principle can guide the scaling up of expenditures on prevention, although turning this into practice requires detailed work on the marginal cost-ef- fectiveness of di?erent approaches to prevention. Furthermore, for incentives to be compatible, it is important that any partition of the costs of treatment between aid agencies and the governments of the countries a?ected should be matched by the parti- tion of the costs of prevention. If, for example, governments paid for prevention whereas donors paid for treatment, governments would have insu?cient incentive to prevent the spread of infection. For a sustainable outcome, a path needs to be found that will stabilize and eventually reduce the number of people needing treatment. This may require an initial investment in a big push. The cost of such an in- vestment may be beyond the means of poor countries, but it would be appropriate for donors. The triumphs of medical research have created a new agenda for public policy that will require some long-standing silos to be overcome. There is an urgent need for practical engagement between medical research, health care professionals, and economists to inform public policy in af- fected countries. Health ministries need to work much more closely with ?nance ministries. Sir Paul Collier, Ph.D., is Professor of Economics and Public Policy at the Blavatnik School of Government, a Professorial Fellow of St Antonys College, and Co-Director of the Centre for the Study of African Economies, Oxford. AUTHOR BIO CULTURES Vol 1, Issue 2 ┬╗Page 63 COLLIER</p> <UL><LI><a href="http://www.mzines.net/publication/643/colfslwvw/1/1/">Front-Cover</a></LI> <LI><a href="http://www.mzines.net/publication/643/colfslwvw/2/2/">Inside-Front-Cover</a></LI> <LI><a href="http://www.mzines.net/publication/643/colfslwvw/3/3/">Page-1</a></LI> <LI><a href="http://www.mzines.net/publication/643/colfslwvw/4/4/">Page-2</a></LI> <LI><a href="http://www.mzines.net/publication/643/colfslwvw/5/5/">Page-3</a></LI> <LI><a href="http://www.mzines.net/publication/643/colfslwvw/6/6/">Page-4</a></LI> <LI><a href="http://www.mzines.net/publication/643/colfslwvw/7/7/">Page-5</a></LI> <LI><a href="http://www.mzines.net/publication/643/colfslwvw/8/8/">Page-6</a></LI> <LI><a href="http://www.mzines.net/publication/643/colfslwvw/9/9/">Page-7</a></LI> <LI><a href="http://www.mzines.net/publication/643/colfslwvw/10/10/">Page-8</a></LI> <LI><a href="http://www.mzines.net/publication/643/colfslwvw/11/11/">Page-9</a></LI> 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