Tools for Fighting the AIDS Pandemic
By Alexander Irwin, Joyce Millen and Dorothy Fallows
Myth: AIDS is mostly an African problem.
Fact: Of the 42 million people around the world who live with HIV/AIDS, 70% are in sub-Saharan Africa. But AIDS is not an African problem:
- HIV/AIDS exists and is spreading in Africa in a socioeconomic context created by western colonialism and, more recently, western trade and economic policies.
- HIV/AIDS continues to spread in the rest of the world, especially in countries or communities within countries where poverty, inequality, and conflict are prevalent. Eastern Europe and Central Asia have the fastest rates of spread, followed by countries in Asia and the Pacific, the Caribbean, and Latin America.
Myth: To stop the spread of HIV, people simply need to give up promiscuous sex and drug use.
Fact: Socioeconomic structures around the world constrain many people’s ability to make free choices regarding the behaviors that put them at risk for contracting HIV/AIDS. Economic insecurity, gender and racial inequalities, labor migration, and armed conflict all limit people’s ability to avoid exposure to the virus.
Myth: Money for AIDS in developing countries goes into the pockets of corrupt officials.
Fact: Corruption exists in countries throughout the world. But it should not slow donor contributions:
- Individual citizens, groups, the media, and government officials worldwide have shown increasing awareness of and commitment to fighting corruption in recent years.
- New international institutions and initiatives, such as the Global Fund to Fight AIDS, TB, and Malaria, have stringent selection and monitoring mechanisms that ensure accountability among funding recipients.
- Many countries with long histories of corruption have established successful HIV/AIDS programs; examples include Thailand, Uganda, and Brazil.
Myth: The best way to control AIDS in the developing world is through prevention. Costly treatment should wait until prevention programs have been fully funded and deployed.
Fact: Prevention and treatment should have equal roles in the fight against HIV/AIDS:
- Since wealthy individuals have the chance to prolong and improve their lives with HAART, it contradicts the principles of equity and human rights to allow tens of millions of others to die without treatment.
- Countries in which large numbers of working- and parenting-age adults die have suffered and will continue to suffer enormous social and economic losses, from which it will be increasingly difficult to recover.
- Efficacy of prevention programs is limited. Prevention efforts often clash with a socioeconomic situation that does not allow people to control their exposure to the virus. Furthermore, even a very successful prevention program cannot fully stop the spread of the virus in high-prevalence countries.
- Prevention and treatment together have a synergistic effect. Voluntary counseling and testing, a key prevention strategy, is much more successful when tied to a treatment program for those who test positive.
Myth: AIDS treatment in the developing world is impossible because antiretroviral drugs are too expensive and because developing countries lack the sophisticated infrastructure necessary to deliver the drugs. In addition, mishandling of ARVs will lead to increased HIV drug resistance.
Fact: ARVs should be a cornerstone in fighting AIDS in the developing world:
- Treatment for the poor is no longer prohibitively expensive, due to recent sharp drops in drug prices. Both generics and cheaper brand names have become available.
- The enormous economic costs of no treatment outweigh the costs of treatment.
- Evidence shows that treating patients with ARVs can save health systems money.
- Relevant infrastructure is actually present in many regions.
- The delivery of ARVs can be simplified and modified for resource-poor settings
- New partnerships between resource-poor and resource-rich groups are helping to create infrastructure in places it is lacking.
- Drug resistance can be minimized by the creation of locally-appropriate guidelines for treatment. Much of the infrastructure created for national TB programs can be used to administer ARV therapy.
Myth: An HIV vaccine will soon be available, and this will solve the AIDS crisis.
Fact: A vaccine will not solve the AIDS crisis:
- While many advances have been made in vaccine research, significant gaps remain in the scientific knowledge needed to develop an effective vaccine.
- The pace of HIV vaccine research is often slow due to lack of financial incentives to develop such a vaccine. Lack of coordination among researching groups exacerbates the problem.
- Due to the difficulties in creating an effective vaccine, the first vaccines deployed will probably be of low efficacy.
- By the time a vaccine has been developed and fully deployed in developing countries, millions and millions of people will have become infected and died of HIV/AIDS if no other steps are taken.
Myth: The pharmaceutical industry’s drive for high profits, together with its political power, means that pricing policies will never change to benefit poor people with AIDS in the developing world.
Fact: ARVs are becoming cheaper in the developing world and can become cheaper still:
- Generic versions of ARVs are produced in some countries and are exported to other countries; this will be allowed by WTO rules until 2005.
- The advent of generics has also driven down the prices of branded medications.
- History has shown that grassroots movements can influence corporate and government agendas.
- Several potential compromises between drug access and profits exist, including bulk buying of ARVs by governments to ensure drug supply for developing countries and profits for drug companies; a differential pricing system wherein drug prices would be adjusted according to the wealth of the country; the creation of new, publicly funded drug companies devoted to developing drugs for diseases prevalent in the developing world.
Myth: Since resources are limited, officials should concentrate on problems that effect large segments of the population, such as nutrition, clean water, maternal & child health, and immunizations, rather than expensive and complex AIDS treatment that helps only a few.
Fact: AIDS treatment would have far-reaching benefits, since the disease has such devastating social, economic, and general health effects:
- AIDS kills primarily young adults in their prime working years; these deaths are devastating to economies.
- Agriculture is gravely threatened by HIV/AIDS. As workers die, food production falls, the nutritional status of the population is undermined, and all aspects of health are affected.
- Young children are often left parentless, leading to hunger, poor health, lost educational opportunities, economic and sexual exploitation, and loss of future prospects.
- AIDS fuels the spread of other infectious diseases, such as tuberculosis.
- AIDS treatment will help reduce pressure on health facilities by reducing opportunistic infections.
Myth: The AIDS crisis in the developing world has no impact on American interests. Citizens and politicians have little to gain by fighting the pandemic.
Fact: Halting of the spread of HIV/AIDS will benefit Americans in the areas of public health, the economy, and security:
- Ever-increasing tourism, migration, and business travel will transport infectious diseases such as HIV across national boundaries at ever-increasing rates.
- TB, made more prevalent and more infectious by HIV/AIDS, will pose a growing threat to Americans.
- AIDS reduces profitability of multinational corporations operating in the developing world due to illness-related absenteeism and worker deaths.
- AIDS significantly reduces the GDP of countries in many parts of the world, weakens markets, and makes trading partners less reliable. World economic growth and the American economy suffer as a result.
- AIDS destabilizes societies and economies in high-prevalence countries, which leads to political instability and collapse. The CIA has officially designated the global AIDS pandemic as a threat to US national security.
Myth: Ordinary people in rich countries can do little to help fight AIDS in poor countries.
Fact: AIDS activists have accomplished much in the fight against HIV/AIDS both in America and abroad. Looking to the future, there are many things individuals can do in the struggle against the pandemic:
- Educate ourselves and our communities in order to create a grassroots response to the AIDS crisis.
- Join (or create) organizations, and form alliances with other organizations, celebrities, or media groups; power often grows with numbers.
- Lobby policymakers through letter-writing, petitioning, and education campaigns to convince lawmakers that Americans want more of their public funds going to global AIDS work.
- Raise money, especially for the GFATM, vaccine research programs, and NGOs. We can make personal contributions, organize fund drives, and encourage contributions from corporations, foundations, and our government.