Tuesday, November 22, 2005

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The difficulty of doing good on HIV/AIDS

UNAIDS released a good news/bad news kind of report yesterday about the state of the AIDS epidemic. These paragraphs from their press release capture the nature of the problem:

Despite decreases in the rate of infection in certain countries, the overall number of people living with HIV has continued to increase in all regions of the world except the Caribbean. There were an additional five million new infections in 2005. The number of people living with HIV globally has reached its highest level with an estimated 40.3 million people, up from an estimated 37.5 million in 2003. More than three million people died of AIDS-related illnesses in 2005; of these, more than 500000 were children.

According to the report, the steepest increases in HIV infections have occurred in Eastern Europe and Central Asia (25% increase to 1.6 million) and East Asia. But sub-Saharan Africa continues to be the most affected globally with 64% of new infections occurring here (over three million people).

"We are encouraged by the gains that have been made in some countries and by the fact that sustained HIV prevention programmes have played a key part in bringing down infections. But the reality is that the AIDS epidemic continues to outstrip global and national efforts to contain it," said UNAIDS Executive Director Dr Peter Piot. "It is clear that a rapid increase in the scale and scope of HIV prevention programmes is urgently needed. We must move from small projects with short-term horizons to long-term, comprehensive strategies," he added.

The report recognizes that access to HIV treatment has improved markedly over the past two years. More than one million people in low-and middle-income countries are now living longer and better lives because they are on antiretroviral treatment and an estimated 250 000 to 350 000 deaths were averted this year because of expanded access to HIV treatment....

Levels of knowledge of safe sex and HIV remain low in many countries - even in countries with high and growing prevalence. In 24 sub-Saharan countries (including Cameroon, Côte d'Ivoire, Kenya, Nigeria, Senegal and Uganda), two-thirds or more of young women (aged 15-24 years) lacked comprehensive knowledge of HIV transmission. According to a major survey carried out in the Philippines in 2003, more than 90% of respondents still believed that HIV could be transmitted by sharing a meal with an HIV-positive person.

David Greising has a front-pager in the Chicago Tribune about the efforts of Abbott Laboratories to help Tanzania cope with the AIDS epidemic. The story highlights the fact that this is not simply about access to cheap medicines:
For five years now, Abbott has worked with Tanzania's government to alleviate the impact of AIDS. The experience has taught the company that the biggest obstacles are less obvious, and less readily overcome, than getting drugs to the villages.

Hospital laboratories are archaic. Treatment wards are overrun with patients. There is little capacity to treat AIDS-related illnesses such as tuberculosis and malaria.

Tanzania cannot adequately care for the orphans of AIDS victims. A social stigma against AIDS victims persists, which deters people from getting tested and treated for the disease.

"People who simplify this into just drop-shipping gobs of drugs into remote areas of Africa, they're nuts," said Miles White, Abbott's chief executive, during a trip to Tanzania last month to review the progress of Abbott's work. "It's a lot more complicated than that."....

Dealing effectively in Africa also means avoiding pitfalls that have hit other donors.

The United Nations-supported Global Fund to Fight AIDS, Tuberculosis and Malaria early this year cut off support for five programs in Uganda, citing widespread mismanagement. In Kenya, skepticism over the government's ability to deliver drugs has led church-backed organizations to form a private distribution company.

Merck & Co. teamed with the Bill & Melinda Gates Foundation five years ago to launch a groundbreaking $100 million program to aid Botswana, where 37 percent of the adult male population has AIDS. But the donors have found it difficult to distribute money, in part because of bottlenecks and logistical difficulties.

posted by Dan on 11.22.05 at 10:12 AM


Anyone who has spent time in a third world country could have told you how absurd it was to try to "solve" the AIDs crisis in poor countries with First World solutions. It always calls to mind the Professor on Gilligan's Island, pedalling away on a bamboo bike to power a bamboo irrigation system or computer (yeah, right). Shame on Jeffrey Sachs and all the other do-gooders who set themselves up for failure on this score. The bad news is that none of the short-term objectives set out for "managing" AIDs are likely to be met, and donors will start to question the strategies set out just a few years ago. Then, as now, prevention is a realistic goal; treatment for the masses is not. We've been diverting manpower and money from the attainable in pursuit of a chimera.

The good news is that, while AIDs isn't even close to being dealt with on a global scale, some of that money may actually make peoples' lives better on the ground anyway. Better health care (and distribution systems), cleaner water, hopefully decent homes and schools for AIDs orphans are all within the grasp of aid groups and governments. I think it's ridiculous that infrastructure improvements like these need to be related to AIDs to get off the ground, but whatever...so long as they happen.

posted by: Kelli on 11.22.05 at 10:12 AM [permalink]

Somewhat oddly, the word "condom" doesn't appear above. Hmm, check the link:

Others believe Abbott and the Tanzania government should focus more on prevention--the distribution of condoms and counseling to avoid the disease. Abbott pays to train counselors, but not for condoms, an approach that aligns with the controversial stance of President Bush's AIDS fighting program.

posted by: rilkefan on 11.22.05 at 10:12 AM [permalink]

That's because the CIA used the hurricane to poison the oil. With Jews. That's how they melted the glaciers.

posted by: P. Froward on 11.22.05 at 10:12 AM [permalink]

It is interesting that Eastern Europe is among the regions with the sharpest increase in infections. Don't these countries have good infrastructure, at least good enough so that logistics will not be a problem for donors? And aren't the people in these countries well educated? Causes of failure against AIDS are probably different in this part of the world than in Africa.

posted by: Kerim Can on 11.22.05 at 10:12 AM [permalink]

The notion that people in the developed world shouldn't be treated is absurd. First of all, treating the infected helps prevention greatly. Reducing the viral load greatly diminished the chances of new infections. Secondly, if you look at countries like Botswana, 1/3 of the working age population would die in like 5 years if there was not a treatment program. The productive capacity of that country would collapse, making things all that more difficult to deal with. While Botswana is an exception in many ways, no one believed their program would be successful when they first proposed it. Now that it is, everyone is saying that it can't be successful anywhere else. I'm reminded of the story of those standing around saying it can't be done being passed by someone else. Only looking to prevention is not sustainable in large numbers of countries.

And the reason the rate is on the increase like it is in Eastern Europe is due to the injecting drug-users being a potent vector. Cracked out people with needles tend to do a really good job of spreading HIV. This is why needle exchange programs are so important.

posted by: J. Sams on 11.22.05 at 10:12 AM [permalink]

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