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The Politics of Africa’s
Pain
by John Price
More than 38 million
of the world’s 40 million people living with AIDS have no
access to medical treatment—an immense catastrophe caused
by the political and moral bankruptcy of wealthy nations,
said AIDS treatment advocates gathered at the XIV International
AIDS Conference in Barcelona.
Treatment activists and experts,
convening a special session on the day before the opening
of the conference, charged the U.S. and other Western countries
with gross and willful neglect, if not criminal behavior,
for their ineffective response to the global crisis of HIV/AIDS,
the leading cause of death in Africa.
“If I as a doctor ignore
a sick person in desperate need of care, I am committing medical
malpractice, and can be charged with a crime,” said Dr. Morten
Rostrup, head of Médicins Sans Frontières (MSF), a humanitarian
medical aid agency with operations in more than 80 countries
“Today and every day,
more than 8,000 people with AIDS will die,” warned Rostrup.
“Yet the international community refuses to mount and fund
an adequate global response—we are faced with nothing less
than a crime against humanity.”
Currently, of the 40 million
people living with AIDS worldwide, about 730,000 people are
receiving antiretroviral treatment—500,000 of whom live in
high-income countries. In sub-Saharan Africa, where 2.2 million
people died of AIDS last year, only 30,000 people received
treatment.
Since their discovery in
the mid 1990’s, antiretroviral (ARV) drugs have proven highly
effective at combating the voracious growth of HIV within
the human body. The virus attacks and destroys the body’s
natural immune system, making it susceptible to a legion of
opportunistic infections. When unchecked by medication, the
virus replicates with a fury, producing 10 billion copies
each day.
Effective antiretroviral
therapy not only directly benefits people living with AIDS,
but also reduces the staggering social and economic impact
of the epidemic in poorer countries. Yet, despite continued
advances in AIDS medications, these drugs remain out of reach
for the vast majority of HIV-infected people in the developing
world.
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Treatment advocates claim
that the most obstinate barriers to accessing medication are
caused by the dubious political will of affluent wealthy countries.
For example, major pharmaceutical corporations, who largely
control the world’s treasure chest of ARV medications, seem
wholly out of step with the global pandemic. Claiming the
need to protect their investments, drug companies have held
their medicinal formulas under lock and key, making it difficult
if not impossible for poorer countries to manufacture or import
generic versions of patented drugs.
According to the Health Global
Access Project (Health GAP), despite some recent slacking
in the tight corporate grip on AIDS meds, patents block generic
replication of at least four ARV drugs in 27 African countries
and at least one ARV in another 31 countries.
It has also not gone unnoticed
by treatment activists that the pharmaceutical industry spends
$13 billon per year marketing their wares directly to doctors—more
than the estimated cost of arresting the spread of AIDS globally.
Advocates claim that the free market-driven system encourages
investment in treatments of conditions like male baldness
rather than HIV/AIDS.
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Some Western experts, however,
have claimed that even if a bottomless pot of funding were
available for AIDS drugs in Africa and other developing countries,
treatment would not be feasible in resource-poor settings.
These experts argue that poorer countries lack the medical
infrastructure to support ARV regimens.
Last year, Dr. Anthony Fauci,
a National Institutes of Health infectious disease chief and
one of Bush’s key advisors on HIV/AIDS policy, stated that
an adequate healthcare infrastructure that would support the
use of ARV drugs in developing countries “just doesn’t exist
right now.”
But treatment advocates at
Barcelona flatly disagreed and brought their evidence in hand.
“The feasibility of treatment has never been more certain,”
said Alan Berkman, founder of Health GAP, who joined colleagues
from MSF to present a study on seven African nations that
have successfully implemented ARV programs in resource-poor
settings.
MSF researchers presented
data at the conference from seven ARV pilot projects in developing
countries including Cameroon, Kenya, Malawi, and South Africa.
The data showed that providing effective treatment in resource-poor
settings has concrete clinical benefits and dramatically improves
the quality of life for individuals and families.
Patients in the seven observational
projects entered treatment programs in advanced stages of
AIDS and were treated with ARV therapy in local health clinics
in poor townships, rural areas, and outpatient units at district
hospitals.
After six months, over
80 percent of patients showed undetectable levels of virus
in their blood, and researchers reported that patient compliance
was impressive, with 95 percent of patients taking their treatment
properly at six months.
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“There are some people who
say that in Africa people will not be able to take these drugs
because they cannot tell time,” said Fred Minandi, an HIV-positive
farmer from Malawi who has a wife and two children—invoking
the now infamous statement of Bush U.S. Agency for International
Development chief Andrew Natsios. “I may not have a watch,
but I can assure you that since I started taking my triple
therapy in August last year, I haven’t missed one dose.”
Minandi, who lives in the
Chiradzulu district, is one of the first patients to get free
medications through the MSF project that began in Malawi in
2001. An estimated 800,000 people in Malawi are living with
HIV/AIDS.
Treatment advocates argue
that one of the most formidable barriers—and telling deficiencies—to
scaling up the availability of AIDS drugs is the failure of
wealthy nations to mobilize promised resources for the Global
Fund to Fight AIDS, TB and Malaria and other financing mechanisms.
Donor nations have abandoned their responsibility, say advocates,
and repeatedly broken promises made over the last two years
by pledging only 8 percent of the estimated funding necessary
to fuel an effective global response to the AIDS pandemic.
Advocates say that the U.S.
set the donor bar extremely low by initially offering only
$200 million, less than 10 percent of what many experts believed
should have been offered by a country commanding the world’s
largest economy.
“The United States
alone should provide $1 billion at least for starters,” declared
U.S. Representative Barbara Lee to a crowd of around 1,500
activists gathered at a treatment access rally in Barcelona.
“And then the entire world must step up to the plate.”
The heavily burdened resources
of the Global Fund were designed to be split between HIV/AIDS,
malaria, and tuberculosis. Moreover, funds allocated for AIDS
must be spread across multiple programs for treatment, prevention,
and care, leading many advocates to question whether the fund
was designed as a formula for success or for failure.
“What we learned on
September 11 is that in a few weeks it’s possible to mobilize
a massive political and financial response to a perceived
common threat,” said Rostrup, who recently returned from an
ARV treatment project in Nairobi, Kenya. But when it comes
to AIDS in Africa, said Rostrup, “There is clearly a problem
of political will.”
“The AIDS crisis is
about political will and moral will,” added Berkman, who believes
that the pandemic has escalated “from a tragedy to a crime.”
He also believes that the
Western obligation for funding might best be understood in
the historical light of reparations owed to Africa for colonization
and to African Americans for slavery. “The U.S. can say that
we don’t owe reparations but we do,” said Berkman. “The disrespect
for African lives that we are witnessing in the AIDS pandemic
and in various other forms is deeply rooted in the racial
patterns in colonialism, slavery, and American society.”
John Price is a health
reporter for the New York Amsterdam News. His work
has also appeared in numerous publications including the New
York Daily Journal, Quarterly Black Review, Tennessee
Tribune, and the Milwaukee Courier. His work has
also appeared online at BlackPressUSA.com
and SeeingBlack.com.
Price was recently awarded the Kaiser Media Fellowship in
Health for 2002. Reprinted courtesy of www.BlackAIDS.org
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