Lack of Trained Health Workers, Infrastructure Largest Barrier to Antiretroviral Drug Access, Doctors at ICASA Say
The largest barrier to the widespread distribution of antiretroviral drugs in developing countries is the lack of properly trained doctors and health care facilities, according to physicians attending the 13th International Conference on AIDS and Sexually Transmitted Infections in Africa, the AP/Newport News Daily Press reports. "Access is a pie, if you will, and one of the slices is pricing and drugs and the challenges of getting them there. But there are others: infrastructure, training ... the success isn't that you get X number of pills there, but what happens to once they are there," Jeff Richardson, executive director of Tanzania Care, a partnership between the Tanzanian government and drug maker Abbott Laboratories, said. Tanzania Care has begun refurbishing hospitals, revising training programs for medical personnel and expanding the number of HIV testing centers. Although the group wants to speed up the process of distributing antiretroviral drugs, it does not want to do so "in a way that will only last a year or two," Richardson said. According to the AP/Daily Press, Tanzania's health system is in "shambles" -- hospitals have few drugs or laboratory tests to offer to patients and the majority of doctors know little about antiretroviral drugs.
Treatment Access in Kenya, Botswana
Medecins Sans Frontieres presented a different scenario involving its treatment access program in Kenya, which has streamlined antiretroviral treatment in order to expand access to care as quickly as possible, according to the AP/Daily Press. However, despite the group's usage of simplified techniques, the lack of health care facilities and trained staff still provide barriers to treatment, Dr. Saleban Oman, field coordinator for the program in Homa Bay, said. Dr. Tendane Gaolathe, co-director for infectious diseases at Botswana's national hospital in Gabaronne, said that Botswana -- which has the largest and oldest national antiretroviral drug program -- has seen several positive developments with the increased availability of drugs, including an increase in the number of people who get tested for HIV and a reduction in the number of AIDS patients who take up bed space and other hospital resources (Tomlinson, AP/Newport News Daily Press, 9/25).
Ethical Drug Distribution Guidelines
UNAIDS Executive Director Peter Piot on Thursday said that African governments could face revolts if they give preference to the elite when distributing antiretroviral drugs, Agence France-Presse reports. Although rationing of antiretroviral drugs will be inevitable in the early stages of widespread distribution programs, countries must develop ethical guidelines to determine which patients will have access to the drugs first, Piot said. Of the estimated 75,000 Africans currently taking antiretroviral drugs, most are "men in power or men with money," Piot said. However, approximately 58% of the nearly 30 million HIV-positive people in Africa are women and 10% are children under age 15. Piot said that although UNAIDS several years ago encouraged countries to set up ethics panels in anticipation of such widespread antiretroviral distribution, "basically ... nothing" has been done in that area except in Botswana. An international workshop held a few years ago laid out clinical criteria for determining the order in which HIV/AIDS patients should be treated. The workshop suggested giving priority first to people with opportunistic infections, then to individuals with early signs of infections and low CD4+ T cell counts and finally to people who showed no symptoms but still had low CD4+ T cell counts. Piot said that the guidelines were flawed because they "gave priority to those who are the sickest ... [and] least likely to really benefit from this treatment." Piot instead suggested that countries set up a "community committee," with equal numbers of male and female members, to lay out ethical treatment guidelines (Ingham, Agence France-Presse, 9/25).
The World Bank on Thursday at ICASA said that South Africa's decision to provide antiretroviral drugs to its HIV-positive residents was one way to prevent possible long-term economic decline, although the agency said that more action is needed to prevent the collapse of Africa's largest economy as predicted in a World Bank report, Reuters/AlertNet reports. The report, which was first issued in July, was reissued on Thursday despite the criticism that it has attracted for spooking foreign investors, according to Reuters/AlertNet (Macharia, Reuters/AlertNet, 9/25). The report estimates that by 2050, South Africa's per family income will be half the amount it was in 1990, dropping to $12,901, suggesting that South Africa's economy could face collapse within about 90 years unless further actions are taken to fight HIV/AIDS (Kaiser Daily HIV/AIDS Report, 7/30). South African analysts criticized the report, saying that the country's economy would be only minimally impacted by AIDS because many HIV-positive people are unemployed and contribute little to the economy, according to Reuters/AlertNet (Reuters/AlertNet, 9/25). The World Bank on Thursday also released a sourcebook on HIV/AIDS prevention programs, emphasizing the role of education in such programs. The sourcebook is based on studies of programs in Mozambique, Senegal, Uganda, South Africa, Tanzania, Zimbabwe and Zambia, Michael Kelly, a World Bank education consultant, said, adding that the resource seeks to provide "a simple forum to help countries share their practical experiences on designing and implementing programs that are targeted at school children" (Panafrican News Agency, 9/26).
There are significant differences in HIV/AIDS prevalence between subregions in Africa, according to a WHO report released on Thursday. The report, titled "HIV/AIDS Epidemiological Surveillance Update for the WHO African Region 2002," found that HIV prevalence in Southern Africa was at least five times higher than in West Africa, with East and Central Africa taking intermediate positions. In addition, population-based surveys indicated that HIV prevalence among African women may be as much as 1.5 times higher than among African men, the report showed. The gender difference may be even more significant among young people, according to the report. About 70% of the world's HIV-positive people live in Africa, despite the fact that only 10% of the world's population lives on the continent, according to Xinhua News Agency (Xinhua News Agency, 9/25).
U.N. Peacekeepers' Role in Prevention
Armed forces can play a "vital role" in fighting the spread of HIV, according to a UNAIDS report released Thursday at ICASA. The report highlights the first large-scale response to U.N. Security Council resolution 1308 passed in July 2000, which called for member states to address HIV/AIDS in peacekeeping missions. "HIV/AIDS poses a particular threat to peacekeeping, a pillar of the international security system. One-third of the officers and soldiers under U.N. command are stationed in Africa," Dominique Mathiot, UNAIDS country coordinator of Eritrea, said. In addition, military personnel are two to five times more likely to contract STDs than the general population, a factor that can increase during times of conflict, according to the report. The report featured a case study on the efforts of the Eritrean Defence Force and the U.N. Mission to Ethiopia and Eritrea, the peacekeeping mission (Panafrican News Agency, 9/26). The UNMEE, working closely with the EDF, provided HIV prevention training to some soldiers, who then trained their peers (Reuters, 9/25). The initiative also included youth, hotel staff and commercial sex workers. The report found that "if equipped with the right information, knowledge and tools, the military can achieve lower HIV prevalence rates than the national average," according to the Panafrican News Agency (Panafrican News Agency, 9/26). The report, titled "Fighting AIDS: HIV/AIDS Prevention and Care Among Armed Forces and U.N. Peacekeepers in Eritrea," is part of a series of new reports aimed at engaging armed forces in the fight against AIDS. Other case studies will highlight the work of armed forces in Ukraine and Thailand, according to a UNAIDS release (UNAIDS release, 9/25).
NPR's "Day to Day" on Thursday interviewed Dr. Desmond Johns, director of UNAIDS' New York office, about ICASA and efforts to change sexual behaviors to fight the spread of HIV in Africa (Grigsby Bates, "Day to Day," NPR, 9/25). The full segment is available online in RealPlayer.