OPINION: On AIDS: Three Lessons From Africa

Monday, August 4, 2014

An AIDS fable: Once upon a time, in the years after AIDS went from being a death sentence to a manageable disease, at least for people rich enough to take antiretroviral therapy, many of the people who ran the world believed that these medicines weren’t appropriate for residents of very poor countries. Even leaving aside the cost, they thought that poor people couldn’t take their medicines on time. Andrew Natsios, the head of the United States Agency for International Development in the George W. Bush administration, argued against funding antiretroviral therapy in Africa. “People do not know what watches and clocks are,” he told the Boston Globe in June, 2001.

The Bush administration got over that idea, and established the President’s Emergency Plan for AIDS Relief — the greatest achievement of the Bush presidency. And the United States is also the major contributor to the Global Fund to Fight AIDS, Tuberculosis and Malaria. In large part because of these programs, which bought generic medicines in enormous quantities, the cost of AIDS therapy has dropped by 99.5 percent. Triple therapy had been $15,000 per year or even more; now some three-drug combinations are $75. And, as we heard at the biennial global AIDS conference in Melbourne last week, AIDS treatment is also AIDS prevention: people who take these medicines consistently are 96 percent less contagious. The treatment that is saving lives has also significantly cut the spread of H.I.V.

But the key word is “consistently.” The viral load of H.I.V. in the blood has to be zero, or near zero. Was Andrew Natsios right when he said that Africans would fail?

At Fixes we’re interested in what separates success from failure. We’re especially interested in positive deviants — the people, places and institutions that are doing much better than others with the same resources. What are they doing that others are not? And what can we learn from that?

Source: The New York Times (link opens in a new window)

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Health Care
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global health, health care, HIV/AIDS, infectious diseases, pharmaceutical industry, public health, reproductive health