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THE staggering events of September 11,
2001 have forced
America to take the lead in a "multi-national" war on terrorism. This is a
battle that must be waged against a worldwide terrorist network
established to wreak havoc and destroy the lives of innocent civilians.
However, there is another menace which is destroying nations and
claiming innocent lives that I fear has either been forgotten…or perhaps
relegated to a "less urgent" place in the minds of Americans, that is the
international struggle against HIV/AIDS.
It is now 20 years into the epidemic, and the situation in sub-Saharan
Africa has become dire. The International Conference on HIV/AIDS held in
Durban, South Africa in July 2000 successfully raised the consciousness of
the world to the plight of sub-Saharan Africa. With the theme, "Breaking
the Silence", a deafening roar was heard, perhaps best by those of us who
were there to witness our generation's holocaust.
Coincidentally, data presented at this meeting confirmed that treatment
for HIV/AIDS could be accomplished with simple regimens that could
conceivably be administered in resource challenged settings. An immense
amount of activity ensued which culminated in June 2001 when the General
Assembly of the United Nations adopted a Declaration of Commitment on
HIV/AIDS, outlining the importance of leadership, prevention, care and
support, societal issues, and the need for local, national, and
international cooperation. Then came September 11th and since then nothing
has been the same.
I have just returned from a week in Kenya, an African country blessed by
nature's beauty and cursed by the scourge of HIV/AIDS.
A Sense of Urgency: KAWI
A newly formed group, the Kenyan AIDS Watch Institute or KAWI, invited me
to visit and learn more of the challenges imposed by the current epidemic.
KAWI is a non-government organization (NGO) formed and supported to date
by concerned Kenyans whose sole purpose is to lend a sense of urgency to
the battle against HIV/AIDS.
In Kenya
alone nearly 15% of the population is infected with HIV/AIDS. Over 700
Kenyans die of complications of the infection daily. At least half and up
to 75% of hospital beds are occupied with HIV/AIDS patients. Some beds are
occupied by up to 3 Kenyans simultaneously dying of AIDS. Of those
infected the vast majority is between the ages of 15 and 49, many of who
are parents and breadwinners. With over 2 million infected, conservative
estimates are that over 700,000 meet treatment criteria for initiating
antiretroviral medications (ARVs). Currently, it is estimated that less
that 3,000 HIV infected individuals are receiving appropriate therapy.
Business As Usual Attitude
In a speech
given on November 25, 1999, the President of Kenya,
Daniel arap Moi,
declared HIV/AIDS a national emergency. Despite this declaration of war,
as well as the U.N. Declaration adopted nearly 2 years later, the battle
has been approached both internally and externally with a "business as
usual attitude". Efforts and dollars have been spent on well intentioned
but poorly organized educational and prevention campaigns.
True Understanding
Words, not action, abound, and the pace and success of the efforts
contrast sharply with the current rapid mobilization of resources and
personnel being employed to wage the war against terrorism. The stigma of
HIV/AIDS remains enormous. Effective large-scale screening measures are
essentially absent, and even the most basic care is lacking for most.
Despite recognition of the word HIV/AIDS, true understanding of the
illness and its consequences are generally lacking.
Perhaps most frightening is that despite the catastrophic death rate,
prevalence is increasing due to the rate of acquisition of new infections.
As these new cases progress to AIDS and death, the social, spiritual, and
economic backbones of this nation will be broken.
We
Americans, as part of the international community, now dedicated to
destroying terrorism cannot ignore the "other war". We must be part of an
urgent international effort to assist KAWI, Kenya and other countries in
assembling organized, comprehensive, and effective national programs to
combat the disease.
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Foreign Aid vs Politics
The effort to combat HIV/AIDS must not be handled in the traditional
manner of tying foreign aid to politics. We must act with a sense of
urgency and purpose and approach the battle against HIV/AIDS with the same
resolve and commitment that we are using to fight terrorism. Toward this
goal we require international cooperation and leadership.
It is time for the Global Fund to Fight AIDS, TB, and Malaria, as proposed
by the well-known Harvard economist, Jeffrey Sachs, to be organized,
empowered and adequately funded so that it can act. In concert with
governments and NGOs such as KAWI, an effective battle against the spread
of HIV/AIDS must be immediately mounted.
Destigmatization A Must
Infected individuals must be identified, educated, and referred for
treatment. The uninfected must be counseled on how to maintain their
health. It is particularly important for serodiscordant couples to be
identified, counseled, and appropriately triaged for care. However, as we
learned here in the U.S., screening can only be successful if those
identified as infected are protected.
Destigmatization efforts must be active, not passive. Foreign aid
must be tied to advocacy for the rights of the HIV infected individuals so
that they are not denied housing, employment, education, the right to
marry, and access to medical care. Furthermore, unless an effective
treatment program is put into place, then knowing one's status will never
be looked upon as an opportunity to preserve health, prevent further
transmission to loved ones, and allow for planning to prevent vertical
transmission to infants.
A Crime Against Humanity
The cost of lifesaving antiretroviral drugs (ARVs) to treat HIV infection
has dropped precipitously over the past year. Due to availability of
generic drugs as well as the response of the pharmaceutical industry,
treatment that once cost in excess of 1000 USD per month, can be delivered
for as little as 1 to 2 USD per day. However, the cost of these drugs must
be assumed by an International Fund.
Furthermore,
the use of funds must be strictly controlled and supervised. Misuse of
these funds for personal gain should be considered a serious crime against
humanity and punished accordingly. Training of health care providers is
required for the responsible use of these potentially life saving drugs.
HIV/AIDS treatment centers are urgently needed to provide treatment to
significant numbers of infected individuals. Not only will treatment
relieve human suffering and keep young people
productive and
healthy, but also it will assist in stemming the spread of HIV/AIDS.
Treatment options will encourage individuals to be tested. With reduction
of levels of virus in HIV-infected persons, sexual transmission and
vertical transmission to newborns during breast-feeding are likely to be
reduced.
The war against HIV/AIDS needs to be
re-invigorated, today, with action and not words. As is the war against
terrorism, the battle against HIV/AIDS needs to be coordinated, well
funded, purposeful, and mounted with a sense of urgency and righteousness.
Only then can we, as an international community, succeed.
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