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Aids Epidemic Still Spreading

A World Health Organization initiative to provide anti-retroviral drugs to people with AIDS in low-income countries fell short of its goal of three million people by 2005. Two experts discuss the effectiveness of the initiative and the challenges of fighting the AIDS epidemic.

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    On this day two years ago, the World Health Organization proposed a bold initiative called "3 by 5." The goal: To treat three million HIV-infected people worldwide by the end of 2005. That number, it's now clear, will not be met. But the effort has provided lifesaving drugs to more than one million people to date.

    We assess the initiative and look at the work ahead with: Stephen Lewis, United Nations special envoy for HIV-Aids in Africa– he's author of a new book, "Race Against Time," that examines the AIDS epidemic; and Salih Booker, executive director of Africa Action, an organization which works for human rights in Africa. Welcome to both of you.

    Stephen Lewis starting with you, how well has the 3 by 5 Program worked?


    It's worked moderately well. It's made a tremendous impact in terms of finally getting significant anti-retroviral therapy out, as you indicated, to over one million people.

    I think what is important about it is that we've unleashed a momentum that is now irreversible, and as I travel through southern Africa, country after country is moving heaven and earth to get more and more of its people into treatment. So that at least is a glimmer of hope amidst the otherwise sense of despair, which engulfs much of the continent.


    Well, give us some specifics. Remind us how the drugs work. Who exactly is getting them? Who are these million people? Mr. Lewis? You can hear me?


    Yes, I can hear you now.


    Okay. I was asking you for some specifics of who was getting the drugs, and remind us how they work.


    Well, the drugs are not a cure. The drugs simply prolong life, and the drugs are primarily from the generic drug manufacturers in India, which are called triple combination therapy.

    They're three drugs in one tablet taken twice a day, once in the morning, once in the evening. The regimens are easy to adhere to. The resistance and side effects are relatively minimal. It makes people feel much better almost overnight. They eat more. They feel healthier. They go back to work.

    It keeps the parents alive. You diminish the number of orphans, and the flow of drugs is fairly consistent now as the generics come into the countries through the support of the global fund to fight AIDS, tuberculosis, and malaria, and the presidential initiative in the United States.

    And it is making a tremendous difference. I mean, we are keeping people alive under the most difficult of circumstances.


    Salih Booker, how do you assess the situation with the 3 by 5 Initiative so far?


    Well, certainly treatment was the right focus. 3 by 5 was a modest initiative. We have to bear in mind they were simply trying to put three million people on treatment in low- and middle-income people in countries who needed it, out of a total of six million people who without medicines will die.

    So the fact that we were only able to achieve one million out of the three target is deeply concerning. And, of course in Africa, which is the front line of this pandemic, less than 10 percent of African HIV patients who need access to medicines have those anti-retroviral environmental medicines available to them now.


    In Listening to both of you, starting with you, Salih Booker, is it a glass half full-half empty type of thing for telling the public, all of us, what is going on?


    Well, it's certainly half full, maybe a tenth full. But Stephen is right; there is momentum, which is new, because for so long treatment was just being ignored, and there was only a focus on prevention. So now, that's right. There's new momentum; the right to treatment as part of the right to health is widely being recognized.

    When you have obstacles of inadequate funding, you have still obstacles from the big pharmaceutical companies that are more interested in protecting their intellectual property than in patients' lives.

    So we have momentum, but it's just not fast enough; the progress is just not fast enough.


    Mr. Lewis, one of the issues that's always been out there is the question of to what extent countries, developing countries are able to effectively use the money that is there and effectively use the drugs that do come to them.

    Do you see some improvements in your trips to Africa and the rest of the world?


    Oh, yes, there are improvements. I share Salih's view, that it is a calamitously low number of people who are in treatment. One would wish it was four, five or six million, but I think of the context, and the context was that the world was immobilized. We were inert. We were not responding. There was terrible negligence in the international community and a good deal of silence and denial in the African community, and we at least have broken through that, and we're now getting more and more people into treatment.

    What is prohibiting it or inhibiting it strongly now, as you have implied, is the absence of capacity in Africa. I mean, people have to understand extraordinary numbers have died — doctors, nurses, clinicians, pharmacists, community health workers — right at the moment when we have the drugs, we lack the human capacity to get them out.

    And so everybody is attempting to train and refurbish capacity and to give the African countries the kind of support they need because God knows they have the sophistication and the knowledge at the grassroots of Africa to turn this pandemic around if the western world will provide an adequate flow of resources and other support.


    How do you see this capacity question? And related, I think, is the question of stigma that has always been there in Africa and in other countries that many have seen as getting in the way of getting things done, more done.


    On the capacity side, often from a donor perspective, they might refer to this as absorptive capacity. They say the developing countries, particularly in Africa, can only absorb so much by way of funding because of bottlenecks in healthcare delivery systems.

    I think the answer to that is you need to invest more precisely in developing that capacity. In other words, if you have a problem in the supply chain of getting medicines out to rural clinics, et cetera, if you have difficulties with access to clean water, the response is to not say, we'll have to withhold funding until there's greater capacity.

    You use this funding, the billions that have been promised, to invest in creating more effective and integrated healthcare systems in Africa. This is what African governments and civil society are trying to do.

    So, you know, I think the capacity problem can certainly be addressed. And it's not all within ministries. There are so many NGOs, people, organizations representing people living with AIDS that are part of the effort in the fight against AIDS in Africa. So capacity can be addressed. Resources are really the key constraint there.

    On the issue of stigma, certainly it's still a major problem but progress has been made, particularly because of AIDS activists in Africa demanding that their governments wake up, open their eyes, and acknowledge that this is a priority for everyone in their countries.

    The president of Nigeria, for example, began today by going for a run with HIV-positive patients in Nigeria. Across the continent, you have initiatives, like the All-Africa Conference of Churches, putting on its web site, "The church is positive." All are efforts to try to do away with stigma, which is a key obstacle to wider treatment and prevention efforts in Africa.


    So, Mr. Lewis, I'm wondering, on a day like this, World AIDS Day, when the world is looking in at the problem, what should we see as the next goal, or are specific targets a useful way to think about the problem?


    Oh, I think specific targets are a very useful way to think about the problem, and I think that the world has generally embraced the proposition of universal access to treatment, prevention, and care by the year 2010.

    That was given testament by the G-8 back at the Gleneagle Summit in July. It was just reaffirmed by UN AIDS in a report they released last week. It's generally agreed now that's the target.

    And, by the way, with treatment comes prevention. A lot more people get tested, and with treatment there is also a diminution of stigma. I was just a couple of days ago in Rwanda visiting a very famous American doctor, Dr. Paul Farmer who has done remarkable things in Haiti and now is collaborating with the Clinton initiative in Rwanda to build a health apparatus that provides treatment, and it's astonishing how the whole community rallies around when treatment is broadly available and stigma diminishes.

    I've seen that done by Doctors Without Borders in Uganda through to Mozambique. We can beat this thing. What is harassing everyone is the uncertain flow of resources to keep the pipeline filled with drugs, and the need to give support around the building of capacity.

    And if the international community continues to betray every promise it makes — and it's already started since the G-8 summit was held — then this World AIDS Day will be looked back upon in a lamentable fashion.


    All right, we have to leave it there. Stephen Lewis and Salih Booker, thank you very much.

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