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Dr. Darkoh was eloquent, but
also forthright, in his plenary talk, “Challenges and
Lessons Learned in Implementing Antiretroviral Therapy in
the Developing World.” The talk detailed the work of
Botswana’s national HIV program, of which Dr. Darkoh
is operations manager
.He did not hide the fact
that one of the problems faced was with healthcare workers.
Some of them did not want to work on HIV/AIDS and created
stumbling blocks rather than promoting the government’s
new efforts. Many were simply uncomfortable discussing HIV.
This then became a matter
of education and guidance—another problem to resolve.
Dr. Darkoh said that one obstinate worker could put efforts
months behind, and HIV programs must continuously look for
people who are a hindrance.
But the greater problem is
simply staff training and fast-track recruitment. Then there’s
the need for laboratory and clinical facilities. As he said,
“Capacity is not something you achieve instantly. HIV/AIDS
did not create the restraints we’re facing. They were
there a long time ago.” The information and education
needs alone were “massive,” he said.
In Botswana, the government
determined that 300,000 people have HIV and roughly a third
of them needed antivirals “immediately.” However,
it could only provide medications right away to 10,000 people.
People with less than 200 T-cells or an AIDS-defining illness
were immediately eligible for antivirals, but the national
program recognizes that all people with HIV need health monitoring.
They also need pyscho-social support and wellness care.
“People were coming
to us late, with an average of 50 to 60 CD4 cells. Sickness
made them overcome stigma,” he said. This was one challenge:
people who do not come forward for health care until they
are very ill will then need many resources. The lesson is
to encourage routine testing. Botswana conducts an educational
campaign to combat stigma and get people to know their status.
It also distributes posters
to help people with HIV understand the infection: that medication
must be taken correctly, that therapy can help make people
healthy but is not a cure, that condoms still need to be used.
Dr. Darkoh called many of
the different challenges “sliding bottlenecks.”
The question of political leadership was “quite a challenge
in itself.” Then there are macroeconomic factors: “Most
countries couldn’t tell you how many people need therapy
or where to find them. You spend lots of time here in the
heat of the epidemic.”
Not all of the work needs
to be high-tech. “It could be, but could be someone on
a bike, like the initiative in China,” he said. Adherence
is promoted with a buddy system, along with pill counting
and intensive counseling. And, as almost everywhere, there
are experts from other countries helping to build Botswana’s
program. Dr. Darkoh himself is from the United States, born
to Ghanaian parents, who earned a medical degree and a Master’s
in Public Health from Harvard University and an MBA from Oxford.
He was recently profiled in the Christian Science Monitor
in a story on Africans and people of African descent returning
to help the continent.
According to the article,
published September 30, “In Botswana, 38 percent of adults
are HIV positive and life expectancy has plummeted to below
40 from over 65. By 2010, [life expectancy] could sink to
29, predicts the United Nations Program on HIV/AIDS—a
level not seen in developed nations since the Middle Ages.”
To help Africa
Speaking before the annual
meeting of the Midwest AIDS Training and Education Partners
(MATEP) in Chicago in September, African American doctor Eric
Goosby said, “I have a plea to all of the HIV healthcare
providers here. I want you to put in your head that you can
make an extraordinary contribution by coming in to these countries
for six weeks. Working directly with healthcare providers
in Africa would provide the best training possible for them,”
he said.
Dr. Goosby is CEO for the
Pangea Global AIDS Foundation, located in San Francisco. He
was director of HIV/AIDS Policy for the U.S. Department of
Health and Human Services under the Clinton administration.
Dr. Goosby directed people to visit Pangea’s website
at www.pgaf.org
for information on how to contribute your service. He said
healthcare providers can also recruit patients with home care
service information to impart.
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