Africa's AIDS Campaigns - Time for Optimism?
It's hard to be optimistic about the subject of HIV/AIDS. India, Russia and China, are in various stages of epidemics and denial. Caribbean and Africa populations and economies are devastated by the disease. Statistics on South Africa's AIDS epidemic show that by 2003, 5,300,000 people were living with HIV/AIDS and 1,100,000 children were orphaned as a result of the disease. The statistics, however, are too low. 370,000 AIDS deaths were predicted for 2003, but the actual registered deaths turned out to be 456.7 thousand. Although statistics show that 21.5% adults (15-49) in South Africa are infected with the HIV virus, in some regions and among child-bearing women the rate is as high as 37%.
Most people acknowledge the news as depressing. However David Brooks, columnist for the New York Times is more optimistic. Brooks recently traveled through Africa, toured hospitals and sent his observations from Windhoek, Namibia. Brooks was cheered, he wrote in his editorial, to "run across health care workers", or "run into people like the 6-year-old daughter of AIDS afflicted parents who named her "Haunapawa" (which means 'there's no good in the world'), or "run into scenes..[where] patients can wait eight hours..to receive medical care and counseling."
But despite what seems like overwhelming misery Brooks says: "..you expect, or at least I expected, to find unrelieved sadness. But something positive has happened recently because of the confluence of three factors...The first is the spread of antiretroviral treatment programs." Mr. Brooks notes that "...the U.S. and other countries are pouring in money to pay for treatments". He's right to note the improvements. But overreaches by suggesting: "there's something perversely akin here to Silicon Valley in the early 1990's..."
Brooks paints a new picture of Sub-Saharan Africa, not of a grim land of poverty, 40% unemployment and whole villages being wiped out from AIDS, but a of a place like Silicon Valley, where money flows in the streets, AIDS drugs for all. Just like free soda and snacks during the dot com era?
Reality, An Uphill Battle
Contrary to Brooks' comparison however, there's little to associate the flood of dollars looking for lucrative investment during the dotcom with AIDS aid to Africa. Only 8% of people who are infected have access to anti-retrovirals, while millions have no access to medication.
Brooks says:"African governments have gone on the offensive against the disease." However in some places, such as South Africa the opposite is true. Health minister Manto Tshabalala-Msimang went on the offensive not on behalf of AIDS patients, but against pharmaceutical companies with drugs. Under intense pressure nationally and internationally, she reasoned in August 2004, just months ago, after years of denial about HIV and AIDS, that the government was "soberly considering" the use of AIDS medicines.
Last month, in a typical flip flop, she resisted urging from the UNAIDS and the World Health Organization(WHO) for more widespread use of antiretrovirals, suggesting instead that people eat well and use "garlic and lemon", olive oil and beetroot. She has repeatedly condemned the "unknown side effects" of AIDS medicines and so convinced populations not to use them.
Other countries have been far more proactive developing an AIDS campaign. Uganda combated the disease head-on, designing a comprehensive strategy that was pushed at the highest levels of government. The "ABC" counted on -- 'Abstinence', 'Be faithful', and 'Condoms', three legs, two of which formed the cornerstone of the Bush AIDS policy.
However a recent study suggested that it wasn't A & B, 'abstinence' and 'be faithful' that were responsible for the decrease in infection rate, rather it was C & - condoms, and even more dire, D - death. The authors note that so many had died in the first wave of the epidemic, a fact that that would make the infection rate decrease the population fell due to mortality.
Brooks observes that the money is flowing in. But many people would argue the opposite conclusion, that the money has not been forthcoming enough. In 2003 Bush pledged $15 billion ($10 billion "new") over the next 5 years for the AIDS crisis. But in 2004, the first budget year of his pledge, Bush asked for only 2 billion dollars from Congress. Congress overwrote the president and approved $2.4 billion. In 2005, Bush sought only $2.4 billion, Congress overwrote that and awarded $2.9 billion.
Not only has the money been parceled out sparingly, aid is stymied by debates around ideological issues. Some dispute the focus of President Bush's money dispersal -- now 20% of funds are funneled to abstinence programs, half of which are explicitly slated for religious organizations.
Organizations that promote condom use have had funding shut off. In a move that has drawn intense criticism, the U.S. has tied aid to pledges against prostitution, which would leave a large percentage of AIDS afflicted populations without care has drawn intense criticism. Donations cannot generally be used to buy generic drugs, only Federal Drug Administration (FDA) approved drugs can be used, and American companies are favored.
AIDs Aid
A recent UNAIDS report about Africa stresses that aid and government action need to be intense and thoughtful. The report outlines three scenarios that would yield possible HIV/AIDS outcomes by 2025. The first would focus on prevention for the least effective outcome, and would cost the U.S. $5-6 billion per year. Another would focus on ART but ignore other pressing issues and the U.S. would spend up to $4 billion a year. The last would attempt to implement what it takes to decrease the numbers of deaths and orphans and the incidence of disease- which would cost the U.S. $10 billion dollars per year.
There are many theories about aid in general, some disagree that aid is affective, some believe that we should spend more - post-haste. Hospitals, hospital wings, and staff is essential. One could reasonably argue that there is an "AIDS industry". However, for those who believe there is too much money going to Africa, Jeffrey Sachs of Columbia University's Earth Institute responds:
"The U.S. is not pulling its weight right now." "[There is] a great myth in the US [about aid], the problem is it's on such a small scale that it's not commensurate with the challenge."
The U.S. provides the smallest amount 'of development aid of the world's 22 wealthy nations, about 15 cents per day per American'.
Often economic considerations such as return on investment ROI couch aid as some kind of sweet business deal that's plugged in pithy marketing campaigns with a dollar signs scattered throughout as often as periods. Like any complex problem, the outcomes of the AIDS epidemics are complicated. While they can be modeled economically such analysis too often ends up as a spending debate, shall we spend this money or not? Let's not. Action on climate change suffers a similar fate.
Optimism?
Do we have reason to be optimistic when places like South Africa struggle with "crumbs" of international private investment. Despite the depressing picture, the history of HIV/AIDS shows that in the endless series of set-backs, punctuated by halting steps forward, optimism is essential -- even though it might not be Brook's brand. Here are some reasons to be optimistic:
- Three years ago antiretroviral treatment (ART) was still shunned in favor of abstinence, on cost and ideological grounds. That's slowly changing.
- Four years ago treatment costs became feasible, largely because of generic drugs manufactured in countries like India and Brazil, often in defiance of US and international patent regimes. The generics are easier to administer as well as being more affordable.
- South Africa's president Mbeki is slowly being convinced that the HIV virus does cause AIDS, although from the sounds of it maybe the Health Minister is now shilling for him.
- In 2001 South Africa won a major lawsuit against U.S. pharmaceuticals over patent rights for essential medications.
- Brazil's experience keeping its AIDS epidemic in check in the 1990's and early 21st century via universal treatment programs and staunch national and international political determination was a beacon of hope for developing countries.
- Strong leadership from NGO's and organizations like the Clinton Foundation, paved the way for acceptance of ART treatment, even as many apologists claimed treatment wouldn't work because of transportation hurdles, costs, culture, protocol adherance, corruption, health infrastructure and lack of training.
- Brazil, Thailand, Uganda and Senegal, geographically distinct countries with very different challenges and populations, each managed a level of success because at the highest presidential and cabinet levels there were strong commitments to their programs. There was a sustained determination to combat AIDS. Their heads were out of the sand. Women were an integral part of the solution, as was treatment for all populations, testing, education, and money.
- The United States is contributing money, expertise and counsel to the efforts.
Brooks concludes at the end of his article:
"[I] now realize we should be redoubling our efforts out of a sense of opportunity. I came aware of controversies about abstinence versus condoms in AIDS prevention programs, about U.S. aid versus multilateral aid, and now realize that all that nonsense is irrelevant on the ground."
This is hopeful. Its easy to be discouraged to the point of ineffectiveness because the grim facts lead people to dismiss Africa as a lost cause. The endless spectacle - "orphaned AIDS victims" - tug endlessly at our heart and purse strings. The effect is numbing. However the solution requires our full-fledged, reality based commitment. It has been said that HIV/AIDS is one of the biggest challenges of our century. Optimism feeds determination, feeds activism, feeds success.
