The Bangkok Post - Monday, August 15, 2005
Franklin Cudjoe

On a tour to launch his foundation and provide support for six severely hit African nations, Mr Clinton identified the lack of medical infrastructure as a barrier in the fight against the disease. One is unlikely to hear such sensible opinions from African politicians or international health bureaucrats.

The WHO announced in 2003 that it wanted to put three million people on ARVs (anti-retrovirals) by the end of 2005 _ the so-called ``three by five'' programme. The tragedy of this approach is that, by prioritising treatment over prevention, another five million people have since become infected with HIV. According to the best estimates, only about one million people will be on ARVs by the end of 2005, meaning that the WHO's strategy has allowed the epidemic to worsen.

Worse, there is a danger that by obsessing over treatment of HIV/Aids, other curable diseases will be ignored. This is because HIV/Aids has achieved a high political profile.

In July, the Group of Eight leaders _ apparently suffering from the same delusions as the WHO _ announced they want to ensure near-universal access to ARVs by 2010. They just do not seem to have learned. How many millions of people will have to become infected with HIV before the political cliques of the world realise that prevention must have priority?

Brazil's prevention programme, for example, has kept the infection level below 0.5% of its population. In a rare show of defiance, Brazil has become the first nation to refuse a $40m USAid grant for fighting the disease, because it was conditioned on denouncing prostitution.

But, while Brazil's prevention programme is a model for all countries afflicted with HIV/Aids, its treatment programme is less suitable. First, Brazil is well developed compared to most African countries, with a GDP per capita of US$8,000 _ compared to $2,300 in Ghana, for example. As such, it has the cash to afford a national treatment programme.

Secondly, Brazil also has the infrastructure. There is an average of 206 doctors per 100,000 people in Brazil and they have good facilities where they can test people and monitor their progress. Brazil has been able to get 160,000 HIV-infected people on anti-retroviral therapy.

By contrast, out of an estimated 40 million infected in sub-Saharan Africa (60% of the world total), only 40,000 are reported to have access to ARVs. In Ghana, only 1,600 out of an infected population of 72,000 have access, partly because there are only nine doctors per 100,000 people. At least Mr Clinton realises how difficult this makes scaling up treatment: ``You just can't get the medicine, ship it into a country and drop it from the sky. If it is going to save people's lives, the medicine must be accompanied by instructions, monitoring, by follow-up and changing the medicine if necessary,'' he said.

But Sub-Saharan Africa averages 12.5 doctors per 100,000 people, with dilapidated or non-existent health structures in most countries. Even transporting the drugs to remote villages is a major problem. Ironically, multinational companies such as DeBeers and Coca-Cola, loathed by anti-globalisation activists, give a lot of help by shipping drugs to the hinterlands of Africa. Coca-Cola, for instance, uses its network of refrigerated trucks and depots to ship large quantities of polio vaccines to remote villages in Africa.

Jim Yong Kim, director of the WHO's HIV/Aids department, is right when he says the key challenge in the fight against all forms of disease in poor countries is to build adequate public health systems and recruit health workers. But none of this will happen in the economic quagmire presided over by leaders of poor countries.

There are no short cuts in the fight against HIV/Aids. Above all, what is needed is a coherent prevention strategy, backed up by a functioning and robust health infrastructure. The UN estimates that 70,000 professionals leave Africa every year. And as long as malignant governments continue to pursue ruinous policies, trained experts will continue to leave.

The governments of poor countries must engage in economic and legal reforms that give the people economic freedom. These reforms would encourage entrepreneurship and innovation, and empower people with information to make life-saving health choices and afford better technologies, clean water and superior energy sources. It is time to empower Africans to help themselves.

Franklin Cudjoe is director of Imani, a policy think tank in Ghana
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