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AIDS: The Lazarus Effect

Researchers call it the Lazarus effect – the dramatic beneficial changes that antiretroviral drugs – ARVs - can bring to HIV/AIDS patients and their families. The drugs are changing lives.

In the biblical story, Jesus is said to have raised Lazarus from the dead. Now, in rural western Kenya, HIV/AIDS patients and their families, in a sense, are being brought back to life.

Researchers say that not only do AIDS drugs restore the health of those who are very ill, but their families respond as well.

University of California at San Diego Associate Professor Joshua Graff-Zivin, co-author of the study, “The Lazarus effect is I think an effect that’s been coined by the medical professionals to describe this sort of pulling individuals from the jaws of death – (an) experience associated with giving ARV treatment to those who have HIV/AIDS. We borrowed the phrase from the medical types to say that there’s an economic Lazarus effect, as well.”

A brighter future

Without treatment, people living with HIV/AIDS usually see their immune systems collapse, which is closely followed by opportunistic infections. The ability to earn a living and provide for their family is lost.

Joshua Graff-Zivin
Joshua Graff-Zivin

“So when you provide this treatment to the individual and make them healthy, then you have this phoenix-like, Lazarus-like effect on the rest of the family where they’re no longer covering for a sick individual and the economic productivity of the household goes up. Investment behavior of the household goes up and they get put on a better economic path,” he says.

Those positive economic effects usually occur within six months of the start of antiretroviral treatment.

“What the evidence suggests,” he says, “is that folks are making more long-term investments. So that is they are managing their farms in a more long term manner. So using more fallow cycles so that they can rejuvenate the fertility of their soil. That means growing a little bit less in the current term in order to have higher productivity in the future, which is consistent with the idea that they would be more future oriented once they recognize that they’re going to be around to reap those benefits.”

Families make other long term investments as well, as the full-effects of the antiretroviral drugs are seen.

He says, “We also see small increases in investments in assets, in particular, livestock. So, clearly, you’re not going to invest in a cow and tie up all that cash now if you’re not going to be around to see the fruits of that investment. And we see some modest evidence of changes in at least preferences for fertility in terms of how many children one wants. But that I think is a more complicated story that we haven’t fully understood yet.”

Cost / benefit ratio

The health and economic benefits seen by the Kenyan families following ARV treatment could enter into the debate over when to start treatment. There’s growing evidence that beginning treatment well before a person’s immune system collapses can bring greater health benefits. But that means governments would need to buy more medicine at a time when the economic crisis has resulted in tighter budgets.

UNAIDS says more than 5 million people in developing countries are now receiving ARV treatment. However, it adds another 10 million should be receiving treatment now.

“I wouldn’t want to take a position on sort of what is clinically indicated. But I would suggest that if the clinical evidence suggests that there’s value in putting people on treatment earlier, then I think what we’d find on the economic side is that we would avert some of this economic downturn within the household. Now, our evidence suggests that economic downturn can be recovered once put on treatment, but it certainly seems to me it would be better to avoid that downturn altogether,” he says.

Stuckler says you cannot separate the welfare of one generation from another when it comes to HIV/AIDS. He says if an adult in the household falls ill and is untreated it has a “profound impact” on the welfare of the other family members. Children, he says, are especially affected.

“When we think about those linkages and we think about the case for intervention – and it is certainly true that it is expensive to intervene – what we need to recognize is not only are we providing health benefits for the patient, but we’re providing a broad set of economic benefits for that patient, as well as the rest of their household. And presumably those impacts on the household spill over onto the larger economy,” says Graff-Zivin.

One of the key partners in the study was the AMPATH program in Eldoret. It’s a partnership between Indiana University in the U.S. and Kenya’s Moi University. Other partners include USAID, the World Bank and the University of North Carolina.