Monday, December 1, 2008

AIDS crisis overblown? Only if you ignore the poor and Africa.

Get a load of this article out ofthe Associated Press:
LONDON (AP) — As World AIDS Day is marked on Monday, some experts are growing more outspoken in complaining that AIDS is eating up funding at the expense of more pressing health needs.

They argue that the world has entered a post-AIDS era in which the disease's spread has largely been curbed in much of the world, Africa excepted.

"AIDS is a terrible humanitarian tragedy, but it's just one of many terrible humanitarian tragedies," said Jeremy Shiffman, who studies health spending at Syracuse University.

Roger England of Health Systems Workshop, a think tank based in the Caribbean island of Grenada, goes further. He argues that UNAIDS, the U.N. agency leading the fight against the disease, has outlived its purpose and should be disbanded.

U.N. officials roughly estimate that about 33 million people worldwide have HIV, the virus that causes AIDS. Scientists say infections peaked in the late 1990s and are unlikely to spark big epidemics beyond Africa.

In developed countries, AIDS drugs have turned the once-fatal disease into a manageable illness.

AIDS advocates say their projects do more than curb the virus; their efforts strengthen other health programs by providing basic health services.

But across Africa, about 1.5 million doctors and nurses are still needed, and hospitals regularly run out of basic medicines.

It is true that HIV/AIDS has become a cause célèbre, mostly because of the way it unexpectedly ravaged populations in the developed countries, especially after it started to affect prominent people in Western Europe, and the US.

HIV/AIDS remains a very serious problem and a problem that continues to grow (1.9 million new infections this year) in Africa. The graph below (from the United Nations Development Indicators) shows the massive effect of AIDS in Africa.

The article points out that there are various other diseases, not to mention crime and war, that ravage the African population. However, a disease like HIV/AIDS has a terrible cost to the health care system that needs to address many of the problems listed above. Direct medical costs of AIDS (NOT including anti-retroviral drugs) is approximately $30 dollars a person/year "at a time when overall public health spending is less than US$10 per year for most African countries."

AIDS has become something people CAN live with (if you don't mind taking a daily cocktail of drugs with various side-effects), if you can afford it. However, most Africans are unable to pay the $300-$1200 required for the Antiretroviral therapy. So, now that the developed countries have successfully shunted the disease off to Africa, the experts in the AP article are looking to funnel HIV/AIDS funds to other diseases. This is not the correct approach, rather these experts ought to look for more funds to fight off other diseases, not try and leach off funds that remain much needed.

These funds are not just needed abroad. This discussion also tends to ignore marginalized populations within American borders. African-Americans in the US have a high infection rate and in particular populations have six times the infection rate than other races. Robert Gallo, a leading voice in AIDS research, prevention, and therapy, wrote a letter to the editor advocating a renewed focus on fighting HIV/AIDS in America's inner cities. Gallo writes:

Sadly, in 2008, some places in the United States, chiefly poor urban areas, are home to the same rising HIV/AIDS statistics as those of some Third World countries. Our institute is in the epicenter of the growing HIV/AIDS pandemic in Baltimore; it provides medication and therapy to more than 5,000 HIV-positive city residents.

The most recent statistics from the U.S. Centers for Disease Control and Prevention show that Maryland leads the 50 states per capita in the rise of HIV/AIDS. Baltimore is one of many cities in need of a Presidents Emergency Plan For AIDS Relief (PEPFAR)-style program to reduce infection rates and increase longevity. Though this pandemic is most prevalent in cities along the Interstate 95 corridor, including Miami, the Baltimore metropolitan area and the Washington metro area, infection rates show that it has spread throughout the nation.

At the same time that many in this country and around the world are working diligently to develop an AIDS vaccine, we must actively address the growing HIV/AIDS pandemic in the United States. When an AIDS vaccine does become available, a program to reduce HIV infection in our inner cities would ensure that our nation is educated and positioned to readily distribute the medicine, helping to put an end to this terrible disease. In the meantime, the program would help stabilize our growing HIV pandemic and stop the spread of HIV.

Unless we develop a program to fight HIV infection in America's inner cities, our urban centers will continue to face an even more daunting pandemic. To improve the health of millions of Americans and to reduce our HIV infection rates, the next administration should craft and implement a PEPFAR plan targeting our inner cities.

If we spend billions trillions on failed banks, automakers, and mortgages the government has an obligation to make a more serious commitment towards this global pandemic that effects marginalized populations both at home and abroad. And yes, they should also commit to fighting pneumonia, malaria, tuberculosis, and diarrhea, but not at the expense of AIDS funding.

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