Amy Goodhew
During the 2009 Swine Flu pandemic, people really wigged out about catching it. Masks became commonplace; international airports became (even more) security mad. Although its symptoms were relatively mild, it spread easily, as did the fear factor. And perhaps there was some basis for fear in certain developing countries, where vulnerability and the subsequent death toll were high. As we near the end of 2009, Swine Flu has killed some 8,500 people worldwide.
But compare that to another pandemic from which, in the year 2009, the death toll reached the 25 million mark.
Acquired Immune Deficiency Syndrome (AIDS) is a killer we’ve grown somewhat complacent about. Perhaps because the majority of deaths were in sub-Saharan Africa or because time has made us more comfortable with it. Either way, it’s hard to imagine that we would be comfortable with such a statistic, were the majority of those 25 million people from the Western world.
A November 2009 report from the UNAIDS agency said that prevention programs are having a significant impact and slowing the rate of new infections. However, others believe that treatment is being threatened.
There are a number of difficulties with treating AIDS that make it challenging, but not impossible, to ensure the best possible care is provided to sufferers. AIDS medication is difficult and expensive to administer.
Even the names of the drugs are overwhelming: Integrase Inhibitors, Entry Inhibitors, Non-Nucleosides Reverse Transcriptase Inhibitors, Nucleotide Analogs, Protease Inhibitors and Nucleoside Reverse Transcriptase Inhibitors, to name a few.
You can imagine the challenges in administering a complex medication regime in cultures that are rural in the extreme. Many people who desperately require treatment haven’t had the advantage of an education to read the drug labels, cannot afford to travel everyday to where the drugs are administered, cannot afford the medication or refrigeration to keep them, who don’t tell time by minutes and hours – as the drugs need to be taken at the same times, but by seasons and the sun.
Additionally, the patent for many of these drugs are owned by profit-driven, multi-national pharmaceuticals whose basic structure does not lend itself to distribution of medications inexpensively. Their mandate is profit, not humanitarianism. Some give away medications to African nations that are soon to expire to access generous tax incentives in the US.
Médecins Sans Frontières (MSF) sidestepped this problem by accessing cheaper, generic AIDS medications that are produced in India. These often combine multiple medications in one tablet and so make them easier and more practical to take.
Four million HIV-positive people are alive on antiretroviral therapy (ART) in the developing world and an estimated six million people are still waiting for access. MSF teams working to treat HIV/AIDS are witnessing worrying signs of waning international support to combat the pandemic. In some high-burden countries, patients are being turned away from clinics, and clinicians are forced into rationing life-saving treatment.
“After almost a decade of progress in rolling out AIDS treatment we have seen substantial improvements, both for patients and public health,” says Dr Tido von Schoen-Angerer, director of MSF’s Access to Essential Medicines Campaign.
"Recent funding cuts mean doctors and nurses are being forced to turn HIV patients away from clinics, as if we were back in the 1990s before treatment was available.”
In Uganda, cuts have already begun to hit home, with some facilities forced to stop treating new patients with HIV.
What does the lack of political will to tackle this virus look like at the coal face, where the truly tough decisions are made?
Olesi Ellemani Pasulani, clinical officer for MSF at the Thyolo District Hospital says, "I can remember what the situation was like before we had ARVs in 2003".
"We could only offer people voluntary HIV testing and counselling. We could only promote the use of condoms and distribute them and we could treat other sexually transmitted diseases. We had a lot of patients in homes that were on palliative care due to terminally ill conditions. There were very few people that came forward to be tested for HIV, because there was not much we could do without ARVs. It was like a death sentence to test HIV positive.
“How can you go back to rationing access to care? It is a right to life. If treatment is threatened it will mean we go back to a situation worse than before ARVs. It will also damage the relationship of trust that communities have built with healthcare workers over the years," he says.
Many organisations (such as the International AIDS Vaccine Initiative) are working to develop a vaccine to prevent the spread of HIV/AIDS. When every second counts towards saving lives, works can’t go fast enough.
The question remains this World AIDS Day, will the world invest the same energy to combat this pandemic as they have for Swine Flu?
Time will tell.
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