Pacific Views

Perspectives on the AIDS Pandemic

"We can always find the money for war. It's time we found the money to fight HIV/AIDS." - Stephen Lewis, closing remarks

I'm attending the yearly AAAS conference, conveniently held in Seattle this time around. I'm attending as a student session aide, so I can't go to everything I'd like. But the portions of a session on AIDS that I caught were gripping.

Stephen Lewis, UN Special Envoy for HIV/AIDS, and former Ontario MP, spoke about the necessity of fighting the epidemic on every front.

Speaking on the subject of international aid, he pointed out that only $57 billion had been available in total. If the industrialized nations kept their promises to donate .7% of GDP, $175 billion would be available. Only Sweden, Norway, Denmark, and Holland now keep their commitments. In later questioning, he said that in 2003, only 4.3 billion was available for fighting AIDS.

He also noted after the session that the Bush proposal for combating the disease should go in greater portion to the global fund. The administration is currently cherry-picking which countries to help. The US program will buy reduced cost brand name drugs, instead of the much cheaper generic medications.

Because AIDS hits the sexually active, it's decimating the working age population in severely affected countries. This was hammered home by the story of a family his team visited in Uganda. A man and his two wives, all over 70 years of age, had raised nine children. Eight were dead, one was dying. They'd left a total of 38 grandchildren in the care of these three elderly people.

In a revelation sure to make eyes bulge in some conservative circles, African women are at the greatest risk of infection from their spouses. The ABC (abstinence, be faithful, condom use) recommendations commonly doled out won't keep them safe. Mr. Lewis stated flatly that the greatest barrier to preventing AIDS was gender inequality.

Thomas Coates, PhD, of UC San Francisco presented on the topic of preventive measures. I only made a very small portion of the lecture towards the end, but one point he made helped build a more complete picture of the difficulties of prevention in Sub-Saharan Africa. He noted that the infected men most likely to engage in risky, unprotected intercourse were married. The likely profile was of a man married for under a year, presenting no symptoms, and prone to having unprotected sex after consuming alcohol.

Helene Gayle, director of the global health program at the Bill & Melinda Gates Foundation, and former director of the USAID AIDS program, talked about the emerging picture of AIDS. Her overriding message was that there's a great deal that can be done to halt the spread of the disease.

By 2010: Current projections anticipate 45 million new infections, 28 million of which could be prevented if action is taken now. 25 million children are likely to be orphaned, and 15% of all children in Sub Saharan Africa will be among them. The rest of the world will outstrip Africa in new cases. Life expectancy in Botswana is expected to drop from a current high of 74 years, due to growing economic prosperity, to a very low 27 years.

Challenging assumptions: Currently, there are 14,000 new cases daily. Roughly half these new cases are women, and around that many of all 14,000 cases affect 15-24 year olds. Also, with the increase of a misperception that AIDS has been conquered, a resurgence is possible in wealthy countries whose rates of new cases were declining or leveling off. The next wave of new cases will likely come from Nigeria, Ethiopia, Russia, India, and China.

Intervention: One of the cheapest interventions possible, condoms, cost between $11 and $17 for each case averted. (There are many ways to avert new cases.) This spending on condoms and various barrier prophylactics averages out to about $1 per year of life saved. Only 42% of at risk individuals have access to condoms. Around $9.2 billion would be necessary in 2005 to aggressively treat AIDS and combat its spread.

During the Q&A, Ms. Gayle responded to a question about what individuals could do. She said that, for one thing, it was important to set a good example locally. But another big concern is a lack of political will. This could be strengthened by community level messages to policy makers that AIDS is a priority, and that the current level of new infection and preventable death is unacceptable.