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Why is the West Ignoring Aids?
Published on Sunday, July 7, 2002 in The Sunday Herald (Scotland)
Why is the West Ignoring Aids?
by Magin McKenna

After five Americans died from contracting the Anthrax virus through tainted mail the US Congress earmarked $4.6 billion dollars (£3bn) in the course of one year to fight bioterrorism. When it became obvious that the Aids epidemic killing millions throughout Africa was out of control America earlier this year promised $250 million, a fraction of the donation of $3.4bn being asked for.

The difference in action and attitude is not lost on the developing countries and those who are fighting to contain an epidemic which has already killed 20 million people and is expected to infect another 46 million in the next eight years, mostly in Africa. New epidemics of African proportions are predicted in Eastern Europe, China and India.

A report released by Medicins Sans Frontieres today at the XIV International Aids Conference in Barcelona shows the resource deficit between developed nations and industrialized ones is mounting. Three of the world's wealthier nations -- the United States, Japan and Germany -- contributed less than 7% of their share this year to the $2.8bn UN Global Fund to Fight Aids.

Of that $2.8bn, only $700m-$800m will be disbursed in 2002, making the situation in developing nations even more bleak, in particular in sub-Saharan Africa where 28 million are infected and where the disease has failed to plateau. The World Health Organization estimates that only 230,000 people of the six million in developing countries who urgently need anti- retroviral drugs receive them because of poor resources and shoddy political infrastructures.

'We are going to continue to face devastation if we don't as a world community wake up to this and put forth the resources that we need to make the difference,' said Helene Gayle, an epidemiologist with the US health department's Center For Disease Control And Prevention.

Gayle is co-chair of the global HIV prevention working group, an independent panel of 40 of the world's leading HIV prevention specialists, which on Friday issued a report outlining a blueprint for bulking up current prevention and treatment programs, while creating new ones. It proposes:

  • Allowing countries to set their own priorities for funding;
  • Increasing capacities of health systems;
  • Expanding successful prevention programs;
  • Improving the tracking of HIV;
  • Encouraging political leadership to act;
  • Dramatically increasing access to treatment in the developing world.

The greatest benefactors of the prevention efforts would be India and China, where it is expected 10 million infections could be averted. In Africa, a 40% reduction in infections could be expected.

'This presents some practical solutions and some things we know are doable,'' said Gayle. ''It's not saying, 'give us the money and trust us.' It's 'give us the money and there are solutions available today'.'

But a delay of one year in implementing the program could increase the projected number of infections by five million. A three year delay could reduce the impact of the program by half. And if countries fail to adopt the simplistic measures, such as condom promotion and distribution, voluntary counseling and HIV testing, empowering women and improving education programs, the research indicates major setbacks.

'It's clearly an expensive program [an additional $27bn would be needed by 2010],' said John Stover, also a study author. 'But the cost of not doing it or delaying the setup is even greater.'

Research expected to set a major part of the agenda for the Barcelona conference shows that it is possible to avoid a grim prognosis offered early last week in a UNAids report which indicated that the disease has far surpassed the worst predictions of its spread set out a decade ago.

A report published yesterday in the Lancet medical journal argues the case for a massive scale-up of resources and prevention measures, which it says could help the world avert 29 million new HIV infections expected to come by 2010.

'We can very substantially alter the course of the epidemic,' said Bernhard Schwartlander of the World Health Organization and one of the Lancet study's authors. 'None of this is inevitable.'

Countries that have already implemented programs similar to that proposed by the Global HIV Prevention Working Group, such as Thailand, Brazil and Uganda, have stabilized the spread of the virus. But Uganda, a country with the most successful HIV-prevention program in sub-Saharan Africa, paints a sobering picture of the challenges ahead. Only 5% of all HIV-infected pregnant women in Uganda have this year received Nevirapine, a drug that prevents transmission of HIV from mother to child in 50% of cases.

But availability of the drug is not the limiting factor, said David Serwadda, of Makerere University's school of public health. Doctors cannot distribute Nevirapine because much of the HIV-infected population lives in rural areas and cannot access the urban treatment centers, he said.

'Over 60% of pregnant women live at home as opposed to at health centers,' Serwadda said.

'We are having to find suitable ways to deliver Nevirapine to them. The drug is increasingly becoming available, but there are other challenges we need to overcome.'

When Dr Badara Samb, director of the World Health Organization's Africa division on Aids, addresses the Barcelona conference via satellite tomorrow night he will demand the international community starts closing the gap in Aids funding inequities between Africa and the West by dramatically upping resource allocations to Africa.

'We have over 40 million people living with HIV/Aids and if this solidarity is not here, it means that nearly 40 million people will die,' he told the Sunday Herald.

Samb believes the money needed is rattling around somewhere, untapped in the world's coffers. 'Come on,' he said, 'that money is in the planet. We are living in a global world. There's been a globalization of the HIV epidemic. It is at everybody's door.'

Last June members of the United Nations General Assembly Special Session on HIV/Aids met in New York to take the first steps in forming a multi- government compact to erode the social and economic factors that leave nations vulnerable to HIV infections -- economic insecurity, underdevelopment, poverty, lack of empowerment of women, lack of education, social exclusion, illiteracy, discrimination, lack of condoms, and sexual exploitation.

The session closed with members promising to identify and begin to address these issues by 2003. A year later, 30 nations now have prime ministers or presidents that sit on a UNAids advisory board.

But critics say the talk has succeeded in setting lofty goals but inspired little action, as developing nations still bear the brunt of infections and receive a fraction of treatment and prevention methods accessible to wealthier nations in the West.

'It is most important that we get more groups from around the world working together for access to care for treatment in developing countries,' says Joep Lange, president of the International Aids Society and one of the conference's key organizers. 'The situation is definitely not improving. We will never have a stable world if this action isn't taken.'

©2002 smg sunday newspapers ltd


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