Thursday, May 20, 2010

Good News - Bad News

If you ask people what is the major problem facing their country, you will probably get a variety of answers. Some will talk about the middle-east wars, terrorism, most will mention the world economy and the recession. If you ask a South African the same question, you may well hear about the economy but it’s not the right answer. The right answer is HIV-AIDS.

A few years ago South Africa edged out Botswana as having the highest infection rate in the world. Of course, many countries don’t have meaningful statistics but they’ll need to have rates of over 20% to be in the running. So how did the situation get so horribly out of control?

Obviously there have to be a variety of reasons which range from cultural behaviours to poverty and lack of education. But I think that the previous president of South Africa must carry considerable blame. An AIDS denialist, he assembled a “think tank” of alternative medicine practitioners to consider the issue. They blamed poverty and poor nutrition for the symptoms and made scathing remarks about the drug industry and its desire to sell useless chemicals to the poor of Africa. Worse, the minister of health, Manto Tshabalala-Msimang, prescribed beetroot and African potatoes as the way to attack the disease. Embarrassingly, she displayed these vegetables at the South African booth at an international AIDS conference. This lady could be a character in one of our stories. She was expelled from Botswana after being accused of pilfering from her patients at a hospital in Gaborone. She rose through the ranks of the ANC to minister of health, but eventually ruined her liver and, despite a controversial jump-the-queue transplant, moved on to higher things. Angry AIDS activists appealed to the Constitutional Court to force the government to supply retroviral drugs at hospitals and won, but the management wheels turned very slowly.

Prima facie one could hardly expect much better from the current president. Falling for a honey trap that led him to court on a rape charge, he famously told the judge that he was not too concerned about the positive HIV status of the lady since he took a shower afterwards! South African cartoonist Zapiro now depicts him in all situations with a shower head halo. But, in fact, President Zuma’s actions belie his behaviour to some extent. He has spoken out firmly, taken public (negative) HIV tests, given his support to safe sex initiatives. The latter includes a campaign to promote male circumcision – a Zulu tradition but previously discouraged due to sanitary issues. The King of the Zulus has added his weight to this campaign. And retrovirals are now free and widely available. There is evidence that the tide has turned at least as far as public opinion and drug availability is concerned. Late, but better than never.

So what’s the bad news? It’s the size of the problem. Third world governments are making retrovirals available to HIV positive people on the basis of cheaper generics supported by huge grants from charitable foundations such as the Bill and Melinda Gates Foundation. But even if the rate of new infection falls significantly – and that is mere optimism at the moment – the total number of people infected is growing at a staggering rate. How many circumcisions can realistically take place in the next few years? Anyway, it reduces the chance of infection but certainly doesn’t eliminate it. 

And the current sufferers are not cured but remain a drain on medication for the rest of their lives. Thus the demand for the drugs increases daily. In the current economic environment, the cost becomes out of reach for third world countries even with international support. Already there are countries where the drugs are available for free, but you have to join a waiting list – essentially having to wait until someone else no longer "needs" the medication. That is, you have to wait until someone else dies. As the list grows, it seems likely that the people at the bottom, like investors in a pyramid scheme, won’t live long enough to get their turns. It’s a grim scenario.

Michael - Thursday.

1 comment:

  1. Michael - This is a problem that deserves discussion but the reality is so bleak that it is difficult to find a way to talk about it.

    In the US, HIV-AIDS is rarely mentioned anymore. There are certainly pockets of the population, especially in the big cities. where there are new cases. The last few years the majority of these have been found in heterosexual women suggesting that there are still men who refuse to use condoms for whatever outdated and selfish notions.

    The institutional Catholic church forbids the use of condoms because they are birth control. I am sure the missionaries, doctors, nurses, and aid workers ignore that mandate and act according to their consciences because they see what is happening to the people. The church does not blame the epidemic on homosexuality as do many of the fundamentalist churches in the US.

    How does someone go about changing minds and attitudes that are cultural? If many children are a sign of virility and fertility, how are minds changed? In the US, the gay population moved quickly to get the message out about safe sex. That information ensured the safety, if people were willing to change, of all segments of the population. We were bombarded with statistics about how personal choices in life meant the difference between life and death.

    It is unfair and impossible to compare the AIDS epidemic in developed countries to that in those that are less developed. One of the earliest posts in the blog was one Tim did about Thailand's light-hearted and, therefore, successful campaign to make condoms available everywhere, as ubiquitous in the bars as matches used to be. But that is one country and Africa is so many countries.

    Making the drugs affordable and available is a big step in reversing the numbers of AIDS related deaths but does a country win the hearts and minds of its people so that they understand that they are killing themselves and their children?