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April 7, 1993

AIDS and Priorities in the Global Village-Reply

JAMA. 1993;269(13):1636-1637. doi:10.1001/jama.1993.03500130050023

In Reply.  —I would like to thank Drs Gellert and Nordenberg for their thoughtful comments. While it is true that diseases other than AIDS, such as malaria and respiratory and intestinal illnesses, have similarly inhibited economic development in developing countries and deserve much more attention than they are currently receiving, I disagree with the implication that AIDS is receiving too much attention. Unlike other diseases, in most developing countries, HIV is continuing to spread exponentially. For most endemic diseases, the result of neglecting interventions for 1 year is another year of about the same level of needless morbidity and mortality. For AIDS, with its increasing spread, the cost of neglect, not only in disease burden but financially, is far greater. Interventions in the early part of a geometrically spreading epidemic like HIV are highly cost-effective because each individual infection averted substantially interrupts transmission.1 Later in the epidemic, the cost-effectiveness