USAID Director Andrew Natsios’ Views on AIDS in Africa ‘Incorrect,’ Op-Ed Says, Calls for ResignationUSAID Director Andrew Natsios' view that HIV treatment efforts should not be undertaken in Africa because the agency "cannot get it done" are "incorrect" and would "condemn 25 million people to death and their children to orphanhood," Amir Attaran, Kenneth Freedberg and Martin Hirsch write in a Washington Post op-ed that concludes by asking for Natsios' resignation. Attaran, director for international health research at Harvard University's Center for International Development, Freedberg, a physician at Massachusetts General Hospital and an associate professor at Harvard Medical School, and Hirsch, director of clinical AIDS research at Massachusetts General Hospital and a professor at Harvard Medical School, state that Natsios' recent comments on AIDS in Africa -- in which he "argued strenuously" that USAID should not distribute antiretrovirals in Africa because HIV-positive individuals there "don't know what Western time is" and thus cannot keep to a drug regimen -- are "to say the least, disturbing, if not alarming." Below are some of the views expressed by Natsios as presented by Attaran, Freedberg and Hirsch, followed by their counterpoints:
- In advocating prevention "to the total exclusion of treatment," Natsios "favors only modest changes in the strategies that USAID has relied on for the past 15 years, which ... have clearly failed to stem the pandemic."
- Responding to Natsios' statement about Africans' inability to tell time -- one of his "exagerrat[ions]" of the difficulties of AIDS treatments -- the writers state that knowledge of time is irrelevant, since "nearly all antiretrovirals drugs are taken only twice a day," and "[s]unrise and sunset are just as good as a watch in these circumstances."
- Contrary to Natsios' statement that antiretrovirals must be kept frozen, the authors say that "[n]ot a single antiretroviral drug on the market today needs freezing."
- While Natsios said that "the problem with (delivering) antiretrovirals ... is that there are no roads, or the roads are so poor," the authors state that "millions of AIDS patients live in cities ... where the streets are teeming with cars."
- Finally, Natsios' view that the toxicity of antiretroviral precludes up to 40% of HIV-positive individuals from taking them is "shared by no one in the medical establishment today."