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HIV/AIDS: Simplicity Could Save More Lives
By Marwaan Macan-Markar
BANGKOK, Jul 14 (IPS) - A one time belief that state-of-the-art
hospitals are a must to deliver anti-AIDS drugs in the developing
world was dispelled at the 15th International AIDS Conference,
currently being held in Thailand.
In its place, now, is a view that is key to the ambitious
programme
being championed by the World Health Organisation (WHO) to
provide anti-AIDS drugs to three million people by 2005.
And the WHO is confidant that the alternative it has in mind
works.
''We have seen very effective HIV treatment programmes in
places
where there is no infrastructure at all,'' Dr Jim Yong Kim, director
of
the WHO's HIV/AIDS programme, told IPS.
' 'Because these examples exist, we can no longer say it is
impossible to treat people with HIV due to a lack of sophisticated
infrastructure,'' he added.
During the IAC, being held from Jul. 11-16 in a convention
centre
north of Bangkok, the WHO's new faith in a rudimentary health
care
process was given ample support by a leading humanitarian
agency, Medecins Sans Frontieres
(MSF).
According to MSF, a simplified treatment process, involving
nurses
and clinical officers and even people living with HIV offering
psychological support for those on anti-retroviral therapy (ART),
has
proved a breakthrough in expanding treatment to HIV patients.
''We think that the simplification of treatment is a key issue,''
MSF's
Alexandra Calmy said during a panel discussion on 'Scaling up
ART
in resource constrained settings.'
Little wonder why AIDS activists and public health advocates
who
are here among the over 17,000 participants from 160 countries
are
talking up the significance of what amounts to a revolution in
health
care for HIV patients.
Furthermore, they are turning the heat on the Bangkok
conference
to endorse this measure as the way forward to prolong the lives
of
those afflicted with the killer disease.
For Zackie Achmat, a South African with HIV who has been in
the
vanguard of the struggle to get cheap anti-AIDS drugs for the
world's
poor, the sea change by the WHO was the result of the
passionate
campaigns launched by grassroots groups over the recent
years.
''The most important thing that has happened over the last few
years is the global access treatment campaign,'' Achmat, of
South
Africa's Treatment Action Campaign (TAC) said during a panel
discussion Tuesday.
''When we started the TAC, there were many people and
organizations, including U.N. agencies, who were sceptical
about
the ability of poor people to act and to change,'' he said.
''We had questions about whether poor countries can deliver,''
he
added. ''We had questions about human resource capacity. Most
importantly we had
questions about the ability of poor people to understand how to
take
these
medicines.''
What drove activists like Achmat into a rage was the fact that
life
enhancing drugs were beginning to be produced in the rich
industrialised world but not accessible where needed most -
namely poor communities in the developing world.
The exorbitant price of these drugs produced by the world's
pharmaceutical giants was the main barrier to this North-South
divide.
In 2000, for instance, the bill for a one year's course of drugs
that
would slow down the spread of HIV, the virus that causes AIDS,
was
between 10,000 U.S. dollars to 12,000 U.S. dollars.
But following the intervention of generic drug producers in the
Third World, who offered anti-AIDS drugs at the cost of 300 U.S.
dollars for an annual dose and later to half that price by the
beginning of this year, the price of medication did not stand in
the
way of life.
What had been, though, were the weak health systems in the
developing world, said health experts, given the care,
counselling
and laboratory tests that had to accompany an HIV patient when
on
anti-retroviral drugs.
But now the WHO's '3 by 5' campaign - to get three million
people
in the
developing world on ART by 2005 - has pushed aside that
barrier,
too.
The Geneva-based U.N. agency is not without its critics for
offering
to dramatically scale up the supply of anti-AIDS drugs to the
world
poor, since only an estimated 400,000 people of the five to six
million HIV patients in need of ART were receiving it by the end of
December 2003.
Among those who have challenged the WHO here are Prof.
Joep
Lange, president of the International AIDS Society (IAS), the
independent body of scientists, researchers and medical
experts
that is the co-host of the current biennial AIDS conference.
''If you look at the number of people being treated in developing
countries today, you know that the three million target of the
WHO
will not be met,'' Lange told IPS on the eve of the conference.
Others question the danger of the WHO's campaign triggering
off a
new
strain of HIV resistant to the available drugs in the wake of weak
health systems in the developing world.
For the WHO, the ambitious target it has set is not an issue.
''All
ambitious targets are thought of as too high. The point is to look
creatively and to think if setting such targets mean we can do
better,''
said Kim, the agency's chief for HIV.
And the success of treating tuberculosis in resource poor
settings
across the developing world is what the WHO is turning to when
challenged about weak health systems and the fear of a new
HIV
strain evolving.
''What are critics are saying to the developing world is that our
discomfort with you for not looking like us in terms of health care
systems means that all of you must die,'' said Kim.
It is an argument that has a grim picture to support it. An
estimated
8,000 people are dying everyday in the developing world due to
AIDS
while the availability of ART in the developed world has
guaranteed
life to those afflicted with HIV.
According to the Joint United Nations Programme on HIV/AIDS
or
UNAIDS, 2.9 million people died in 2003 due to AIDS - a
number
expected to be as dismal this year, given that some 38 million
people are living with HIV.
As one AIDS activist at the conference said: ''Access to drugs is
a
global emergency because the number of deaths associated
with
HIV is intolerable.'' (END/IPS/AP/HE/DV/WD/SD//MMM/SI/04)
(END/2004)
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