Monday, July 14, 2003

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Uganda, Botswana, and AIDS, redux

This Financial Times article reinforces what I said last week about Uganda and Botswana being exemplars for the rest of Africa. The key grafs:

Only two African countries have over the past three years taken up an offer by a German pharmaceuticals company to make free donations of an important Aids prevention drug to poor countries.

Boehringer Ingelheim said that only Uganda and Botswana had taken delivery of supplies of nevirapine, the drug it offers free for use in preventing mothers from infecting their babies with HIV/Aids....

The company said that 44 countries were now taking part in the initiative and that it was working with a number of non-governmental organisations in Africa, but only two national governments in the region were involved. Four South African provinces had also applied for donations.

"We are not at all satisfied with how it is running," said Rolf Krebs, chairman of the private German company. "It is very frustrating."

Heavy customs charges, poor logistics and lack of the necessary healthcare infrastructure were some of the reasons why many African countries had not taken part in the programme, he said....

Nevirapine was the subject of a bitter political battle in South Africa where the constitutional court last year ordered the government to make it available to HIV-positive pregnant women following legal action taken by Aids activists.

That last graf is just devastating.

The FT article jibes with what Senate Majority Leader Bill Frist emphasized as necessary for fighting AIDS in Africa in a speech he gave last month at the Council on Foreign Relations:

The U.S. Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003 will provide $15 billion over five years to combat these global diseases. Equally important, it links for the first time the concepts of prevention, care, and treatment into a single comprehensive policy.

Remember ... this little virus was unknown in this country just 22 years ago when I was a surgical resident at Massachusetts General Hospital. Since then it has killed 23 million people.

Through this simple effort, 7 million new infections will be prevented. 2 million people will be treated. And 10 million HIV-infected individuals and AIDS orphans will be cared for.

But just as essential as the money, this law will build a new, robust infrastructure -- to better communicate with health workers, to educate, and to establish delivery systems.

And this infrastructure will serve as the foundation upon which a whole host of other medical and public health issues will be addressed for decades to come.

It's all about the infrastructure.

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