Published on Tuesday, July 9, 2002 by OneWorld.net
New Tests Make Failure to Treat AIDS in Poor Countries 'a Crime'
by Jim Lobe
The world's failure to treat AIDS victims in poor countries with life-preserving drugs has been denounced as a "crime against humanity" by Doctors Without Borders (Medecins Sans Frontières, or MSF) after the group released the results of nine pilot projects at an international AIDS conference in Barcelona, Spain, which opened Sunday.
Opponents of spending more resources on AIDS treatments, including the head of the United States Agency for International Development (USAID), Andrew Natsios, have argued that people with AIDS in impoverished countries around the world, particularly in rural areas of Africa, are not sufficiently educated to comply with doctors' instructions.
"We're not surprised that patients are living longer - after all, we know the medicines work - and we were confident that people would be able to take their medicines consistently, although others expressed skepticism," said MSF's Dr. Jean-Michel Tassie. "But we've nonetheless been particularly pleased with how conscientious people have been about keeping appointments at the clinics and taking their medicines."
The results add ammunition to those who argue that treatment options should get more attention and resources in national and international efforts to curb the spread of HIV/AIDS, which killed an estimated three million people last year and is expected to kill as many as 68 million between 2000 and 2020 in the 45 most affected countries, according to the latest United Nations projections.
The emphasis on treatment, as opposed to prevention, efforts in the international fight against HIV/AIDS is one of the most hotly-disputed topics at the Barcelona AIDS meeting, with groups like MSF and Health GAP, which co-sponsored the new report, 'Overcoming the Treatment Deficit,' arguing that treatment strategies are being short-changed in existing initiatives.
"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 Morten Rostrup, president of MSF's International Council. "Today and every day, more than 8,000 people with AIDS will die. Yet the international community refuses to mount and fund an adequate global response - we are faced with nothing less than a crime against humanity."
AIDS activists all agree that the international community has so far provided much too little funding to seriously address the epidemic, in part because 95 percent of the 40 million people currently infected with HIV/AIDS live in poor countries--about 75 percent in sub-Saharan Africa--that cannot mount an effective response without help.
The UN last year established a Global Fund to Fight AIDS, Tuberculosis and Malaria which it says will need at least US$7-10 billion a year to reach its targets. So far, however, major donors have pledged an average of only eight percent of the required funding, creating a huge shortfall that has intensified the competition for existing funds between those who advocate prevention strategies--such as promoting condom use, changes in sexual behavior, and vaccine and microbicide research--and those who want more funds directed at treatment.
This has led to a growing debate over "cost-effectiveness," with prevention advocates touting one study recently published in the medical journal The Lancet concluding that prevention strategies are 28 times more cost-effective than the cost of treatments, which depend on the use of expensive retroviral drugs.
But treatment advocates like MSF argue that this creates a false and possibly unethical dichotomy. "When public health experts from the U.S. and Europe tell us that we should exclusively focus on prevention because it is more cost-effective," according to David Evans, an MSF doctor in Mozambique, "we have to ask them to consider: if this epidemic was ravaging your community, would you recommend exclusively focusing on prevention and letting the already infected die?"
"Cost-effectiveness studies are economic analyses that are never used to exclusively guide health care policy in the developed world," noted the MSF report.
Moreover, the cost-effectiveness debate ignores the fact that access to treatment creates conditions that improve the effectiveness of prevention programs, in part by increasingly the willingness of those who are being treated to break out of the pattern of denial and stigma which afflicts many poor communities.
To increase the cost-effectiveness of treatment programs, however, MSF calls for much greater use by donor agencies of generic drugs, as opposed to patented drugs from the major Western pharmaceutical companies which, according to the report, have lowered the prices they charge poor countries for their drugs only in response to generic competition.
Copyright 2002 OneWorld.net