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The economic value of reducing the stigma of HIV/AIDS

Stigma can be defined as assigning a mark of shame or discredit to a person or his/her behavior. HIV/AIDS stigma has led to many adverse consequences as those with the disease try to avoid the shame by not disclosing their HIVpositive status and this leads to the unnecessary infection of others and also to a failure to access treatment when otherwise it would be available. In fact, the UN Secretary General Ban Ki-Moon has stated that stigma is a chief reason why the AIDS epidemic continues to devastate societies worldwide [101]. A number of possible interventions exist to reduce HIV/AIDS stigma [1–3]. In Sub-Saharan Africa, there can be educational programs that present unbiased information pointing out that not all those infected pursue behaviors that are either high-risk (injecting drugs intravenously) or what some persons may think morally questionable (males having sex with males) as the majority of the HIV transmission arise from heterosexual activity [4]. In the USA, there can be the repeal of some or all of the legislation in 33 states that criminalizes the actual or potential exposure of HIV [102]. But any stigma reduction intervention involves the use of scarce resources that could be devoted to other uses. The policy issue then is to establish whether the stigma interventions are to be considered socially worthwhile. To do this, one needs to undertake an economic evaluation in the form of a cost– benefit analysis (CBA) that tries to establish whether the monetary benefits of any intervention exceeds the monetary costs [5,6]. Cost–effectiveness analysis (CEA) studies of HIV/AIDS stigma prevention do exist [7,8]. But at present there is only one CBA [9]. Note that a CEA does not establish whether something is socially worthwhile as it does not place a monetary valuation on the output and so it is incommensurate with the costs of the inputs that are expressed in monetary terms. A CEA merely ensures that, provided that one has already decided that some intervention is socially worthwhile, it could then be undertaken in the most cost-effective way (least cost for a given output, or highest output for a given cost). In order to carry out a CBA of a HIV/AIDS stigma intervention, the issue thus revolves around the question of whether the stigma reduction outcome really can be valued in monetary terms. The answer coming from an economist is that anything can be given a price provided that there are appropriate data. However, the response needs to be even stronger than this by saying that a change in stigma must be valued in monetary terms, or else there is a risk that it will be ignored in making an economic evaluation of an intervention that can reduce stigma. This is because there is a real danger that the change in stigma will be classed by a noneconomist as ‘priceless’, which with a literal interpretation means that in practice it will effectively be given a zero price! If there are no reported benefits, then it is not surprising that few economic