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R.R.
Frerichs Posting
This past weekend, experts from 38 countries came to San Francisco to
participate in a workshop on ways to prevent HIV transmission in developing
countries. The first report of the meeting appeared in today's San Francisco Chronicle
(see below). Unfortunately the article does not suggest that much new will
come out of this meeting. Rather than seeking working models of successful
programs for replication in other settings, the focus of the workshop seems
to have been on the need for money to support on-going efforts, as if cost-effective
solutions are already known.
It is not clear that any attention was paid
to unraveling the reasons why some developing countries have very low rates
of infection while the virus flourishes in others, to identifying the successful
elements in Cuba's HIV program or other countries that have kept the virus
at a low level, or even viewing the experiences of groups like the US military
with their comprehensive detection and treatment program.
At the biological level, we look for examples of natural resistance
to HIV to offer clues on how best to attack the virus. While there are
not many resistant persons, those who have been identified are highly valued
by researchers. Such pragmatism has helped medical and biological investigators
understand more about the virus and eventually to develop more effective
therapies.
We need to do the same at the cultural level, seeing what does and does
not work in various national settings.
Why has Cuba been so successful?
Why do Indonesia and the Philippines have such apparent low rates? Why is the virus inapparent in many middle-eastern countries but exploding
in Russia? Why is HIV at high levels among some South Africans, but exists at
much lower levels in others?
There is much to be learned by studying societies and cultures that
have avoided infection, but such study must be done with an open mind,
and should not be constrained by examples of social failure. Our biomedical
colleagues do not spend endless time lamenting that most people are not
resistant to the virus. Instead they find the few that are resistant in
a natural setting and learn from them.
"AIDS rampages through developing world"
By Lisa M. Krieger (San Francisco Examiner, April 22, 1998)
Cheap and simple interventions could significantly slow the AIDS epidemic
in the developing world, but even these modest prevention tools are financially
out of reach of beleaguered nations, according to experts at a UC-San Francisco-sponsored
AIDS conference.
"We know what works. We've shown it's effective. What we need now is
the money to implement them," said Martha Bulter deLister, director of
the Dominican Republic AIDS organization Fundacion Genesis. "We can't wait
for a vaccine," she said.
If affluent governments, corporations and individuals dug deeper and
spent 10 to 15 times more on global prevention programs, the number of
new HIV infections could be reduced by as much as half, according to United
Nations calculations presented at the three-day meeting.
Hard-hit regions
HIV infection is rampaging through Africa, the Caribbean, Latin America
and Southeast Asia, but many countries are unable to afford something as
simple as a blood test to keep their blood supply clean. Nor can they afford
testing and counseling of HIV-infected people to warn against transmitting
the infection to others. And sexually transmitted diseases, known to boost
the risk of HIV infection, go untreated.
Furthermore, mothers pass on the virus to their infants because they
lack access to the brief AZT drug regimen that could interrupt deadly viral
transmission. While much of the globe is riveted by fancy three-and four-drug
anti-viral regimens, costing $25,000 to $37,000 per person a year, an estimated
16,000 men, women and children in developing countries are newly infected
each day.
Conference co-chair Margaret Chesney of the UCSF Center for AIDS Prevention
Studies, working with AIDS specialists from 38 different nations, sought
practical and affordable solutions to the growing epidemic. They estimated
that it costs 50 cents to test blood for the AIDS virus. Several dollars
to cure a sexually transmitted disease. $50 to give an infected mother
a short course of AZT to prevent transmission of the virus to her baby.
Worldwide, about $1.5 billion has been spent each year on comic books,
radio spots and condom rallies in developing nations. But such prevention
efforts have proved to be mere speed bumps, not roadblocks, in the path
of HIV.
Supplies are limited
Blood testing is the official "standard of care" in most nations, but
that is no assurance that it actually happens. Some nations, such as Uganda
and Kenya, have a supply of blood-testing kits -- but then use them up,
and run out. In other nations, the kits are available in the capital, but
not rural regions. Pharmaceutical companies should help serve the communities
that volunteer for drug and vaccine testing, the experts urged. And multinational
corporations that do business in poor nations should consider contributing
to the anti-HIV effort. Without effective AIDS prevention, the countries'
"work force would be wiped out . . . their talent would be wiped out,"
said Thomas J. Coates, director of the UCSF AIDS Research Institute and
workshop co-chair.
The disparity between rich and poor nations has increased dramatically
over the course of the epidemic.
In 1980, about twice as many adults were infected in sub-Saharan Africa
as in North America. Today, 14 times as many are infected there. The cumulative
number of HIV infections among adults around the world has more than doubled
from about 10 million in 1990 to almost 25.5 million by mid-1996. HIV has
disproportionately devastated the developing world. In 1996, 93 percent
of HIV-infected people were in the the developing world.
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