The fight against HIV/AIDS must be part and parcel of the fight against poverty, writes Gamal Nkrumah Last week, the 15th International AIDS Conference convened in the Thai capital Bangkok. The six-day conference highlighted the growing economic repercussions of the HIV/AIDS pandemic, especially in impoverished developing countries. The AIDS conference was entitled "Access for All". "AIDS is a death sentence in poor countries," Dr Jeffrey Laurence of the Weill Medical College at Cornell University, New York, told Al-Ahram Weekly. Worldwide, 42 million people are living with AIDS, of whom some 30 million are in Africa. There are an estimated six million people suffering from AIDS in South Asia; one million in East Asia; 1.5 million in Central and South America and the Caribbean; and one million in Eastern Europe and Central Asia. Dr Lawrence, who attended the Bangkok conference and visited AIDS treatment centres in Thailand and neighbouring Cambodia, was especially inspired by the pilot projects and training programmes for health workers treating HIV/AIDS patients in Cambodia. "Some 50 per cent of all HIV/AIDS patients in a clinic in the Cambodian capital Phnom Phen now have access to anti- retroviral therapy, even though the resources are extremely limited and the patients are desperately poor," Dr Laurence remarked. A coterie of international dignitaries attended the gathering. Among the distinguished speakers were Ugandan President Yoweri Museveni and Hollywood's Richard Gere. The focus of the conference was on increasing the access of the world's poor to anti-retroviral therapy. HIV/AIDS has become an expensive yet treatable chronic disease in the rich nations of the West, which patients can live with for three or two decades, if not more. Even though drug prices have recently come down considerably, the $20,000 annual expenditure per patient on anti-retroviral courses means that such treatment is totally out of the reach of people in poor countries. Indeed, the costs of anti-retroviral therapy are now at the centre of the debate on HIV/AIDS care and treatment. Consequently, so are poverty eradication campaigns. Small wonder then that the Bangkok gathering shifted its attention to the fight against poverty as the key element in arresting the spread of HIV/AIDS. "The conference was not about science, but about political science," Dr Laurence said. For improvements in healthcare provision are contingent on the elimination, or at the very least alleviation of abject poverty. Reduction of illiteracy rates and improved infrastructural facilities also facilitate the reduction of the death rate among HIV/AIDS patients in poor countries. Participants also debated how increased access to anti-retroviral therapy, hitherto largely restricted to rich and industrially advanced countries, can significantly save lives. Access, the participants concluded, includes access to prevention methods -- clean needles and condoms -- as well as to anti-retroviral therapy. In most of Africa, however, "the percentage of the HIV/ AIDS patients that have access to anti-retroviral therapy is very small, rarely exceeding one per cent," Lawrence said. He pointed out that the per capita expenditure on healthcare a year is $10 or less in most African countries. Laurence noted that international organisations like Medicins Sans Frontiers (MSF) are "doing an excellent job in the countries they are working in". He stressed, however, that much more concerted international effort is needed to halt the spread of HIV/AIDS in Africa and alleviate the suffering of infected patients. An estimated 2.2 million Africans died of AIDS last year alone. Indeed, AIDS claimed the lives of 2.9 million people around the world in 2003, the vast majority in poor and underdeveloped countries. The HIV/AIDS pandemic is wrecking havoc on social and economic life in the African continent. Life expectancy in some countries such as Zimbabwe has plummeted from 56.6 years in 1990 to 33.9 in 2002. Indeed, 60 per cent of death claims by employees in Zimbabwe are due to HIV/AIDS. South Africa, the economic powerhouse of southern Africa, could face economic collapse. Former South African President Nelson Mandela was among the speakers at the conference. He highlighted the reciprocity between tuberculosis (TB) and HIV/AIDS, pointing out that patients suffering from the former are at great risk of having the latter disease too. Dr Laurence visited TB clinics in Lesotho and also noted the close links between AIDS and TB in southern Africa in particular. Lesotho, a small mountainous kingdom entirely surrounded by South Africa, has long been considered as one of the epicentres of HIV/AIDS in the region. He also noted the differences in the rates and methods of transmission in different parts of the world. In Thailand, 80 per cent of HIV/AIDS patients are drug abusers, but in Africa the disease is transmitted mainly through heterosexual sex. Everywhere, however, women are far more susceptible to HIV/AIDS infection than men. Participants in Bangkok debated how best to reduce the cost of medicine, especially in light of the cheaper generic drugs now available on the market and manufactured in countries such as India, Thailand and Brazil. There were urgent calls in Bangkok for an increase in funding for HIV/AIDS prevention and treatment. "Ask yourselves what you can do as global citizens in the fight against HIV/AIDS. We must never forget our responsibilities," Mandela said. The first post-apartheid South African president announced that this was his last public appearance as he was retiring from public life. He celebrated his 86th birthday soon after his return to South Africa from Bangkok. "We share a common humanity with our brothers and sisters suffering in this epidemic," Mandela stressed in Bangkok. "I cannot rest until I am certain that the global response is sufficient to turn the tide of the epidemic," he said. "There could be no better birthday gift than knowing that there is renewed commitment from leaders in every sector of society to take real action against AIDS," Mandela said. "No amount of money is too small to make a difference," he added. In Bangkok, the European Union pledged $52 million to the Global Fund to Fight AIDS, Tuberculosis and Malaria. But participants noted that pledges for assistance from rich nations are not always honoured. Indeed, the main slogan of the AIDS activists in Bangkok was "Fund the fund". The government of the United States and several other Western nations -- in tacit agreement with the giant pharmaceutical corporations -- argue against flooding poor countries' markets with cheap generic anti-retroviral combinations. "The US argument is that helping may not help," Dr Laurence said. He explained that the US government believes that because the infrastructure is simply not there in some of the poorest African countries -- partly as a result of very high illiteracy rates -- that the patients will not get regular treatment and that help could cause the development of resistance to the drugs. Dr Laurence does not believe that this argument is valid. "We cannot stop helping until the African countries concerned develop proper infrastructural facilities. That would result in the deaths of hundreds of thousands of people, even millions," he told the Weekly. Alternatively, Dr Laurence advocated the funding of relatively small training centres for healthcare workers who in turn would train HIV/AIDS patients on how best to adapt to and adhere to anti-retroviral regimens. The long-term economic costs of the HIV/AIDS pandemic include reductions in labour productivity, an increased number of the absolute poor including orphans, and increased household vulnerability. In some parts of Africa, aged female-headed households predominate as grandmothers assume the head of household responsibilities to take care of their orphaned grandchildren. On the other hand, an increased number of teenagers and adolescents now head households. And although Africa is the continent that is currently the hardest hit by the terrible disease, some experts believe that the centre of the pandemic has begun to shift from sub- Saharan Africa to South and Southeast Asia. China, once feared as a potential epicentre for the debilitating disease, is now internationally acclaimed for "doing a lot to prevent the spread of HIV/AIDS", Laurence said. China's pilot treatment projects and policies promoting prevention are especially commendable, he added.
