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Ernest Darkoh on HIV/AIDS
 

Tavis: All this week, PBS is airing a major six hour mini-series on global health issues called 'RX for Survival.' One of the experts featured in the series Dr. Ernest Darkoh, one of the world's leading authorities on AIDS in Africa. He developed the Botswana National Antiretroviral Treatment Program, which is the largest AIDS treatment program in the entire continent of Africa. He currently heads his own health care company called Broad Reach. Dr. Darkoh, nice to meet you.

Dr. Ernest Darkoh: Thank you for having me.

Tavis: Glad to have you here. I'm pulling out this blue card, because I, it's hard - as many times as I've discussed AIDS on this program and certainly on my radio program on public radio over the years, these numbers still stagger me every time I hear them, and they keep changing, obviously. Let me just offer three or four stats right quick for our audience to understand the scope of this conversation before I get too deeply in it.

43 million people worldwide infected with HIV-AIDS. 43 million people worldwide infected with HIV-AIDS. The potential by 2010 is 100 million. 100 million people perhaps infected by the year 2010. 100 million people worldwide. 28 million have already died from AIDS related illnesses. 28 million already dead. 8,500 die every day. 8,500 people die every day around the world from HIV or AIDS related diseases.

And this stat, which blew me away about the work that you do, which is a great segue I think, in Botswana where you developed this antiretroviral program, which I mentioned earlier, the most successful program on the continent of Africa. The life expectancy in Botswana had fallen from 72 years to 39 because of HIV-AIDS. The life expectancy had dropped from 72 to 39 years, before you all got involved with this program. So how are thing in Botswana now?

Dr. Darkoh: Vastly improved compared to three years ago when I first arrived. I think when we started the program in Botswana, really it was in response to the - really the permitting of the President of the country, who at that point was faced with a situation whereby 40% of the national population of adults was infected with HIV. And at that particular point in time, unfortunately the global set of implicit and explicit policy had been, there should be no treatment in Africa, just prevention. But obviously faced with the situation where 40% of your population is infected, meant that you couldn't just think about prevention only.

And the President of Botswana basically said that he wasn't going to let 40% of his population die, and therefore he had to explore the feasibility of offering treatment. So at the time when we started the program, frankly I think the country had adapted to a reality whereby there was gonna be, nothing could be done and therefore, very little had been done leading up to that point. So the introduction of treatment really catalyzed sort of the nation getting engaged again in a response - to HIV that previously had been nonexistent.

Tavis: I don't want to cast dispersion on African countries, because we don't - we're still stuck on stupid here in America where HIV and AIDS are concerned. Not doing everything we can here. So it's not just them, it's us as well.

Dr. Darkoh: Exactly.

Tavis: That said thought, there seems to be a disconnect though on the continent where certain leaders are concerned, disconnect between, as you mentioned earlier, treatment and prevention. Thabo Mbeki, the President of South Africa, the gentleman who took over, of course, after Nelson Mandela, has been in a lot of - hot water for years now about the disconnect in his own mind, or certainly in his own policies.

And South Africa is a great country, and they've made great strides since Mandela. But what is it about certain African leaders, certain African countries where there is this - disconnect and while you make great strides in Botswana, South Africa is in major trouble here - where HIV is concerned, largely because the leadership, with all due respect, doesn't understand the connection between treatment and prevention. Why is that?

Dr. Darkoh: Well, I think first and foremost, there shouldn't be a separation between treatment and prevention. Really it's one continuum. In fact, based on my experience, I'd say one of the best forms of prevention is treatment. Because it makes people engage in the issue. The minute you say there's no treatment or no prevention, you end up with perverse behaviors on either side of the fence. I think the genesis of HIV is one that should teach us a lot of lessons as to how to not handle epidemics in the future.

Because the way that the disease was handled from the very beginning, from the way it was pronounced, even from the scientific community in the very early outset, like in the early to mid '80s, - it was really sort of cast as a moral disease. It wasn't - and this was the first disease I think in a long time where we just didn't treat it as a disease, we treated it as something different. With that being the case, I remember at the time I was actually in high school when HIV came out, and across the board, African leaders went into denial. Across the board.

And there were many numerous reasons for that. But one was there was a sense that, you know, everything bad comes out of Africa, so we're not going to let them get away with again blaming us for yet another bad thing coming out of Africa. The second thing was, there's all sorts of sort of moral interlaced - issues associated with HIV that, again, Africans said we're moral people and we're not immoral, and therefore again our message is going to be very clear that there's no HIV.

And then finally, there's the issue of economics. Many African countries were highly dependent on tourism for income, and therefore felt that if they admitted to there being HIV, that may actually have a negative impact on the tourism industry, and therefore again, it's lead to this corralling of opinions around there not - being HIV in Africa.

Tavis: Yeah, but you end up though with these numbers, which still scare people from wanting to come there.

Dr. Darkoh: Exactly. And that's exactly the point of that. By denying it, you just drive things underground, you stop a lot of good things that should have happened from happening in terms of public health interventions. And frankly, I think only one country, believe it or not, which is Cuba, responded appropriately from a public health perspective to the epidemic, and it's evidenced by their current extremely low rates of HIV in their community.

Tavis: You're the expert here. So I want to get your thought about this. But I have long since felt that there are two real problems, and certainly there are more then two, but two real problems that I sense, especially inside of communities of color where HIV-AIDS is concerned. One of them is that Magic Johnson, who is a personal friend, love the brother dearly. We all see magic looking extremely healthy and we know Magic - is a man of means and takes care of himself, and works out. I saw him in the gym the other day. So he works out.

But I think a lot of young people, and I've even had a chance to talk to Magic about this, a lot of people look at somebody like Magic having been pronounced with this years ago. Magic's looking healthy, making money, and running businesses, and still playing basketball, etcetera, etcetera. So I don't know that the right message is getting to them that it is a death sentence anymore. And maybe - in fact, it isn't a death sentence, but it makes people I think a bit more cavalier when they know they can live a long time.

And I guess that's one issue, I want to get your thoughts about how we deal with that, number one. The other issue, though, I think is that people are genuinely of the mindset that this is such a huge problem. I read these numbers off this card and that scares me even. I mean - you're stuck, you got a loss for how you even get a handle on something that ravages the community in this way. So address both of those if you might.

Dr. Darkoh: Okay, well I think on the first issue, you related to maybe - the message now becoming a little bit harder to - get out to people. I do agree with you, and I think for example in quite a few countries, in Europe in particular, you're seeing a resurgence of HIV in the younger communities who didn't grow up with the horror and the ugliness that we saw in the early stages of the epidemic. Because the therapies are so much better, you catch people earlier. You don't see - the ugly side of the epidemic.

That said, I think there's enough information out there that if we can find systematic ways of making sure we're educating people appropriately as to what HIV is, what it does, I think we can still accomplish, you know, the goal of making sure that people are sensitized and acclimatized in the right way, not paralyzed in fear. Because I was also part of - the problem with the early response is people thought the best message to send is one of fear, and all that did is paralyze people, made them feel helpless, and probably continue partaking of the behaviors that they did.

But have a balanced message and say look, this is something that you do never, ever want to get. But if you do have it, there is hope for you, and be able to find a way of sending that balanced message. Now we have many, many channels for getting these messages out that we don't use. Schools, other academic institutions, higher learning, technical institutions, workplaces, for example, where we can tap into existing captive populations to make sure that these messages are going forward.

Tavis: Not to stop you, but what - prevents that from happening, are politics in the way of us using those institutions like schools to get the message out? I mean, you say these vehicles are there, they are there. So what's the problem? Why - aren't we using them effectively?

Dr. Darkoh: First and foremost, often we haven't identified that it is a problem. Like you pointed out earlier in the U.S., I feel the response has been extremely weak. There is a growing epidemic in our inner cities, especially among black and Latino populations. And very little is actually being done in a systematic way. Right, to actually tackle that. But then there's other issues. I think AIDS has always been linked to the moral issue, the morality issues.

And you see that creeping in, in many ways, sometimes in terms of what you're allowed to say, where you're allowed to speak, and to whom you're allowed to talk to about these particular things. And frankly, if we treat this like a disease that it is, we could actually put a lot of that aside and really focus on protecting people, which is the ultimate objective that we would all like to achieve.

Tavis: Do you sense as I suggested earlier that people think it's so big that you can't even get your arms around it?

Dr. Darkoh: Yes, and that unfortunately is also, I believe, limiting the extent of our responses. In many cases, I think the problem does seem so big, so what our responses have been characterized by is, let me just do something. But what we have found, and in fact, that's one of the central sort of tenets around (unintelligible) is to say, let's actually approach this problem with solutions that match it, in terms of the size and scale of our solutions. Often you find people saying, well, yes, it's a huge problem, 40% of adults are affected, so I'm going to start up this little clinic.

Great, you'll start a little clinic that may treat 200 people. But when you have 200,000 who actually need treatment, you're really not getting there. And what we are trying - the message we're trying to get out is that, yes, it can be done, but it also can be done at the scale at which the problem exists. So there are ways of designing programs to treat 40 million people.

But let's start thinking about those, and let's start pulling together the necessary consortia and resources to do that, instead of these little piecemeal solutions that are very laudable, and - I do not mean any disrespect to the people out there who are doing this, but at the moment, if you look at the scale of what needs to happen, and the scale of what's actually happening, we're not going to get there any time soon.

Tavis: I got just a few second left, Dr. Darkoh. Tell me right quick, why it is, given the work that you do, so intimately connected to this, that you personally remain hopeful?

Dr. Darkoh: Because I can't afford - not to. I cannot stand by and watch more than 40 million people die. I feel that I would have let myself down as a person, I would have let humanity down. If I have any talent at all that I can contribute to making sure that that doesn't happen, that's what I'm here to do.

Tavis: I'm glad you're here. Tomorrow night kicks off this 'RX' series on PBS. Check your local listings. That's our show for tonight. You can catch me on the weekends on PRI, Public Radio International. See you back here next time on PBS. Until then, thanks for watching, good night from LA. And, as always, keep the faith.