Friday, Sep 5, 2008
A doctor says the fight to get cheap AIDS drugs to Africa is misguided: These people need water, food and basic healthcare.
Jun 27, 2001 | From the first day of the United Nations Special Session on HIV/AIDS in New York this week, activists, nongovernmental organizations and delegates have clashed over how to face the global epidemic. Not surprisingly, one of the most contentious issues facing delegates is money: whether U.N. Secretary-General Kofi Annan's proposed superfund should be used primarily for prevention of the disease or whether a significant chunk of it should be used to treat those who are already sick with expensive anti-retroviral drugs.
An alliance of groups argues for loosening intellectual-property laws in Africa and easing pharmaceutical patents in order to make available inexpensive, generic versions of the AIDS drugs that have prolonged countless lives in the West. Groups like ACT-UP, Oxfam and HealthGAP have asked the United Nations to use a good portion of its superfund monies to buy those drugs in bulk and give them to developing countries.
But critics of those proposals say that the generic-drugs plan would discourage pharmaceutical companies from continuing to fund AIDS research. More significantly, they say, the sub-Saharan African countries most affected by the disease lack the healthcare infrastructure necessary to distribute the complicated drug regimens. Without that infrastructure, the cocktail treatments would not be effective.
For 16 years, Carole Collins has worked with AIDS patients throughout the world, watching them struggle with the basics of getting clean water and food for the children they will soon leave orphaned. Collins, a public health physician, is the HIV/AIDS policy director for Christian Aid, a London Protestant organization that works with local communities in Africa to provide $85 million worth of AIDS relief each year. In an interview with Salon, she argues that eradicating poverty is the real key to eliminating the AIDS pandemic.
Will the U.N. AIDS superfund provide sufficient monies to combat AIDS in sub-Saharan Africa?
Sadly, I think it will not. The intention may be good, but instead of getting $10 billion, we're going to get $1 billion to $2 billion. For a global fund dealing with three diseases -- HIV/AIDS, tuberculosis and malaria -- that's not sufficient. There's going to be another level of bureaucracy to administer it, and it's going to distract from the central problems of Africa.
If you really want to tackle HIV/AIDS, you've really got to tackle poverty. There is increasing evidence that the whole pandemic is being fueled by poverty. It's the poverty that drives young women into prostitution to feed themselves and their children. You've got no access to healthcare and little or no access to education. Unless we can address those very simple issues, everything else is window dressing.
These debates over anti-retroviral cocktail drugs are obscuring the greater poverty. People are not eating; the levels of malnutrition I'm seeing are astounding. I see people who have almost scratched themselves to death because of the lack of a simple skin preparation. We see people dying of diarrhea for want of simple diarrhea preparations. Drugs are not filtering down to everyone, never mind the more sophisticated ones. Those very basic drugs are not there.
Whenever I go to visit some of our community-based programs and you're led into somebody's home, the first thing that will hit you is that the patient will be on the floor. If that household was not poor before HIV and AIDS infected somebody, then by the end of the first few years, poverty will come to that household as all of their assets are sold off to pay for healthcare. Children have been taken out of school -- daughters, particularly -- to become caregivers. Invariably, the person you come to see will be on the floor without a blanket or a pillow. If you look around that mud hut for food, you won't see it, and you won't smell people cooking. There is no food.
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