Development & Aid, Headlines, Health, North America

HEALTH: AIDS Treatment Tests in Poor Countries Rated a Success

Jim Lobe

WASHINGTON, Jul 9 2002 (IPS) - The results of nine pilot projects in seven developing countries show that poor people, including those with very little if any education, are able to follow an anti-AIDS drug regime that restore them to significantly better health.

So say Doctors Without Borders (Medicins Sans Frontieres, or MSF) and another prominent activist group, Health GAP, in a study released to coincide with the XIV International AIDS Conference this week in Barcelona, Spain. MSF oversaw the projects.

The two groups say the study, which covered projects in South Africa, Malawi, Cameroon, Kenya, Cambodia, Thailand and Guatemala, should result in more resources being devoted to the treatment of AIDS victims.

The project results echo the experience of Brazil, where all AIDS patients are entitled to treatment, resulting in a 54 percent reduction in AIDS deaths between 1995 and 1999.

Most donors have favoured prevention, as opposed to treatment strategies, in 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.

Ninety-five percent of the world’s 40 million people with HIV/AIDS live in developing countries, about 70 percent in sub-Saharan Africa.

The extent to which emphasis should be placed on treatment, as opposed to prevention, efforts in the fight against HIV/AIDS is perhaps the most important controversy at this year’s AIDS meeting, which will continue in Barcelona most of this week.

The World Health Organisation estimates that anti-retroviral drugs have reached only 230,000 of the six million residents of low- and middle-income countries who need them. Half of them live in Brazil, where the government gives the drugs for free. In sub-Saharan Africa, only 36,000 people receive the drugs, according to the United Nations.

“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.”

The United Nations last year established a Global Fund to Fight AIDS, Tuberculosis and Malaria, which health experts say will need at least 7-10 billion dollars a year to contain the spread of the disease. Major donors have pledged only about two billion dollars.

The result is a huge shortfall that has intensified competition for existing funds between those who favour prevention strategies, such as promoting condom use, changes in sexual behaviour, and vaccine and microbicide research, and those who want a greater proportion of the total to be directed toward treating AIDS victims.

Those who favour prevention have argued that it is far more cost-effective than treatment strategies, in part because the latter relies on the supply of expensive retroviral drugs patented by major western pharmaceutical companies. In one study recently published by the British medical journal, ‘Lancet,’ researchers concluded that prevention strategies were no less than 28 times more cost-effective than treatments.

In addition, some major donors, including the head of the U.S. Agency for International Development (USAID) have argued that many poorly educated AIDS patients, particularly in remote rural areas, are less able to follow the strict regimes for treating the disease, and thus investment in such treatment risks wasting what little money is available.

MSF and Health GAP have long taken issue with these assumptions, and the recent study, entitled ‘Overcoming the Treatment Deficit,’ provides ammunition for their cause.

MSF provided low-cost drug therapy to approximately 1,000 patients in the advanced stages of the disease, according to the 15-page report. It found that 95 percent of the patients took their treatment properly for a period of at least six months.

Of 743 patients who were most carefully monitored through the process, not only were 93 percent still living at the end of the six-month period, but they had gained on average more than six pounds and significantly enhanced their overall health.

“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 scepticism,” said Jean-Michel Tassie, an MSF doctor who helped organise the projects.

“But we’ve nonetheless been particularly pleased with how conscientious people have been about keeping appointments at the clinics and taking their medicines.”

MSF said that all of these projects will now be expanded, but it is pushing hard for the donor community to fund more such efforts.

The new report also insists that cost-effectiveness is not being defined in a way that fully takes account the advantages of treatment strategies and the way they may in fact contribute to prevention, as well.

“MSF teams working in Malawi, for example, report that providing AIDS treatment has heped to break a pattern of denial and stigma towards people living with HIV/AIDS,” the report said. “For the first time people are disclosing their HIV status, and a dynamic has been created that has greatly increased voluntary counseling and testing — an important step for all prevention activities.”

Treatment, which often permits AIDS victims to return to gainful employment, also reduces the number of AIDS orphans. About 14 million children living today have lost one or both parents to AIDS, and that number is likely to climb sharply as up to one-half of today’s new mothers are likely to die of AIDS in the worst affected countries, particularly in southern Africa, where adult HIV-AIDS rates range as high as 39 percent in Botswana.

“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, 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?” asked David Evans, a MSF doctor in Mozambique.

To increase cost-effectiveness of treatment programmes, MSF and Health GAP is calling for much greater use by donor agencies of generic drugs, as opposed to patented drugs from the major western pharmaceutical companies.

The major companies, the report noted, have cut prices they charge poor countries for their drugs only when the threat of competition from generic manufacturers has loomed.

 
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