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August 10, 1994

Private Choices and Public Health: The AIDS Epidemic in an Economic Perspective

Author Affiliations

University of California—San Francisco

JAMA. 1994;272(6):490. doi:10.1001/jama.1994.03520060090039

An orthodoxy has crept into much of the medical, epidemiologic, and political thinking about the acquired immunodeficiency syndrome (AIDS). It goes something like this: people living with AIDS are not responsible for their affliction, anonymous testing for the human immunodeficiency virus (HIV) should be vigorously promoted, more money should be spent on research, and AIDS education will have a profound impact on the course of the epidemic.

Along comes this provocative book by two University of Chicago economists who, unencumbered by even the slightest baggage of this politically correct orthodoxy, analyze AIDS from a fresh, if disquieting, perspective: that of economics. For the unfamiliar, this is economics writ large—costs are not simply measured in dollars but include anything that decreases the value of an activity. For example, the cost of risky sex is lower than the cost of safe sex. Why? Because, all else being equal, people prefer the sexual

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