HIV Treatment: Ideology versus reality
Laurie Garrett, a fellow of the Council on Foreign Relations, has a good editorial in today's LA Times.
Bush has a $15 Billion plan for AIDS prevention/treatment which requires a certain amount of the money be spent on teaching/encouraging abstience approach. This emphasis in the Bush plan is a result of the influence of the Christian right who are against the use of condoms.
What will stop the spread of AIDS? Abstinence would help but there is a major problem in changing behavior in the people in the high risk group.
Safe sex using condoms is a proven way to slow the spread of AIDS.
In Uganda, for instance, the government claims HIV "prevalence" dropped from 30% in 1990 to 5% today. Yuweri Museveni, Uganda's president, told the conference that the key to success was a campaign that pushed abstinence before marriage and fidelity after marriage. That no doubt helped, but in southern Uganda, the country's only long-term study shows that the number of new infections there dropped by about 40% between 1990 and 2002, without any significant changes in general sexual behavior. The only factor that changed, according to the study, was an 80% rate of condom use between casual sex partners.
It seems likely to me that Museveni's pronouncement's has more to do with currying favor with the Bush administration than public health.
Antiviral drugs are also important, but alone are inadequate since people who have unprotected sex with someone on antiviral therapy can get a drug resistant strain of the virus which can then be spread further.
Another point from the article.
Politicians may not like the idea of handing out sterile needles to heroin users, for example, but New York City researchers pushed HIV among drug injectors down from a 1990 high of 50% to 15% in 2002 with such a program.
So at the very least a successful HIV tratment program must stress treatment and prevention through the use of condoms. A study by the World bank also supports this idea.
The World Bank did a cost-benefit analysis of funding HIV treatment in India and concluded that the direct costs of providing drugs would be recouped, in the form of a surviving labor force. But it also found that those economic benefits could be erased and the epidemic could swell if India failed to execute a safe-sex condom campaign at the same time.
Garret's conclusion which seems very reasonable
It's time to fully fund treatment programs and prevention programs. Overemphasizing any approach, or, more accurately, oversimplifying the problem, guarantees that at the next International AIDS Conference, in 2006, the world will be facing a pandemic marked not by 5 million new cases a year but tens of millions.
upate Information from GAO study now at end of article
There are other aspects of the US approach to AIDS treatment that came under fire at the International Aids Conference.
......the World Trade Organisation's agreement on drug patents last year. At Doha, it was agreed that poor countries in need of medicines could disregard the 20-year patents on new drugs owned by the multinational drug companies, most of which are based in the US.
The deal, completed at Cancun, lets poor countries buy cheap, generic copies of patented drugs from the makers, in India, Brazil and Thailand. Aids drugs were hugely expensive before such firms made their copies and brought the prices down from $10,000 (£5,400) a patient a year to under $300 (£162).
According to the World Health Organisation, six million people in poor countries need antiretroviral treatment but only 440,000 are getting it.
France accuses US of Aids blackmail
To get around this agreement and thus preserve US Drug company profits, the US has been trying to make bilateral agreements with countries that makes foreign aid contingent on not producing/using the generic drugs. Not only that but the agreements extend patent proctections for the US drugs beyound the usual 20 years. Oxfam has stated that these types of agreements would have a very negative effect on a country's ability to treat aids.
From the Guardian article
"Oxfam shares the concerns of Thai NGOs that a free trade agreement with the US, containing unnecessarily high intellectual property standards, will seriously undermine future access to affordable medicines in Thailand," says the report.
Xavier Darcos, the French minister for cooperation and development, said France wanted to see a global agreement on access to medicines and favoured any that allowed "the countries in most need to access drugs, ideally free, or else produce them".
The British have very strongly broken with the US on this issue.
UK policy on Aids leaves US isolated
The UK yesterday signalled a major rift with the United States over its Aids policies, publicly rejecting the Bush doctrine that sexual abstinence is the best way to stop the spread of the pandemic.
The international development minister, Gareth Thomas, also made it clear the UK did not support the US over its reluctance to endorse the use of cheaper, generic drugs to fight the disease.
Arriving at the International Aids conference yesterday, where America has been relentlessly attacked by campaigners and criticised by UN agencies, Mr Thomas said that the UK was neither prepared to fall in with conservative American thinking nor sit on the sidelines.
It appears to me that Bush's policy is more concerned with maintaining the profits of the drug companies as well as catering to the concerns of his religous base than to implement a well thought out policy. Millions of lives are at stake, but in this administration politics and ideology are the driving forces at all times.
The GAO has found a number of problems with Bush's approach to AIDS.
The GAO interviewed 28 field staff from two government agencies responsible for on-the-ground implementation of the president's plan. The staffs from the U.S. Agency for International Development (USAID) and the Department of Health and Human Services (DHHS) were asked to identify the challenges they faced in getting help to people living with HIV/AIDS in the targeted areas. Of the 28 staff interviewed, 25 cited policy constraints imposed by PEPFAR in the procurement of affordable generic drugs as a major limitation on the treatment scale-up efforts in developing countries.
U.S. Govt Accounting Office to White House: Bush Requirements for Big Pharma Drugs Obstructs Poor Country Efforts to Treat Aids
from the same article
"Bush is selling compassion to American voters this election year, but the real agenda of the White House has been to create a slush-fund for US drug companies," said Paul Davis, domestic policy director for the U.S.-based advocacy group Health GAP (Global Access Project). "The Administration must immediately pledge $30 billion for global AIDS by 2008 and lift the ideological restrictions on the use of affordable generics and condom usage."