The AIDS Funding Dilemma
Tuesday, June 22, 2010
In the “AIDS exceptionalism” debate, emotions run high, and the options are difficult: Shift some AIDS funding to other care, or find billions in new support.
Dr. Jerome Kabakyenga has just walked a pair of visitors through a pair of vividly different Ugandan hospital laboratories – one ultramodern, the other an outdated relic. In the first, highly trained technicians investigate blood samples using a battery of high-throughput computerized systems. The brightly lit, air-conditioned facility is spotless. In the second lab on Kabakyenga’s tour, there’s little equipment beyond a clutter of microscopes, a pair of old refrigerators and a few centrifuges. The technicians here depend on daylight from a set of dusty windows, one of which is cracked. As he completes the tour, Kabakyenga, who is the dean of medicine at theMbarara University of Science and Technology in western Uganda, does his best not to say what’s on his mind. He knows the contrast between the two facilities – both of which serve a population of about 1 million Ugandans in the region around the city of Mbarara – tells a startling story about medicine right across Africa. But today, Kabakyenga wants to let the labs do the talking.
In this tale of two labs, the state-of-the-art facility is one that provides HIV/AIDS testing; it was paid for by wealthy foreign donors. The other facility is the Mbarara regional hospital’s antiquated general diagnostic laboratory, which operates on a shoestring budget provided partly by Kabakyenga’s university department. The disparity between the two labs means that, while many HIV/AIDS patients can get reasonable care, vastly larger numbers of patients – in an area long stricken with numerous other killer diseases besides AIDS – cannot. In a hospital where up to 20 percent of patients have HIV, investment in an HIV/AIDS lab is critically important. But the lack of resources for testing and treating diseases other than HIV/AIDS is disastrous: “We can do rapid and comprehensive viral load analyses for HIV patients,” Kabakyenga says, using the careful cadences of a scholarly man who risks straying into a political minefield. “But we can’t always manage a timely malaria test.”