Important note: Information in this article was accurate in July 2000. The state of the art may have changed since the publication date.| Strengthening the Base Fighting the Global Pandemic Learning from Each Other |
"The problems caused by HIV disease in the developing world are so enormous and so grave that it makes sense for us to devote substantially more of our human and financial resources there," says José M. Zuniga, president of the International Association of Physicians in AIDS Care (IAPAC).
Zuniga has brought a new energy and a new sense of administrative cohesiveness to IAPAC since January 2000, when he stepped up from deputy director to lead the organization. Over the last six months he has logged more than 100,000 air miles working with members, staff, and other organizations to fashion cutting-edge program initiatives.
"We are a catalyst for creating public-private health partnerships," he says, "because IAPAC has the flexibility to move quickly, as an honest broker between government agencies, NGOs, and the private sector to create new working alliances to meet the challenges of HIV. We also bring the unparalleled energy, experience, and talent of our physician members to the mix."
The annual series of IAPAC conferences on Healthcare Resource Allocation for HIV/AIDS and Other Life-Threatening Illnesses is the keystone to the association's social and clinical advocacy and program activities. Many of the members--10,000 physicians and healthcare professionals from 52 countries--will come together for the fourth such conference, which is slated to take place October 16-18, 2000, in Cairo, Egypt. The annual event has proven to be a wellspring of innovation. Ideas germinated at the 1998 conference, in Cancún, Mexico, led to the creation of I-Med Exchange (see page 188), an Internet-based network for education, research, and consultation on HIV disease.
Many have viewed IAPAC "as a US-based and focused organization," says Zuniga. He acknowledges a degree of truth to that assessment and sees expanded international programs as complementing that base of strength. He pledges, "New programs will not come at the expense of existing ones." Zuniga points to IAPAC's efforts to create an HIV/AIDS medical training and certification subspecialty program in the United States as one example of expanded domestic activity. The association also is planning to open a satellite office in Washington, DC, to represent the views of its physician members on key issues. The satellite office will focus on "ensuring access to care for all Americans living with HIV," and work for an increased US government commitment to fighting global aspects of the pandemic, explains Zuniga. "Public health is not simply a matter of what happens within the borders of a single nation, it is international."
He says the newly renamed IAPAC journal, JIAPAC, "will continue to offer comprehensive coverage of key medical meetings" to keep clinicians abreast of state-of-the-art developments in treating HIV disease and its associated complications. The IAPAC Web site, which logs almost a half million hits a month, will also continue to serve as a portal to the latest information to address clinical concerns, Zuniga says.
That includes the matrix of concerns lumped under the rubric of lipodystrophy, more slowly emerging pathologies such as AIDS-related malignancies, and complex questions about how to monitor and manage therapy in an era when stopping, starting, and switching antiviral drugs are evolving into a combination of science and art tailored to individual patients. Beginning in the fall, JIAPAC "will add a peer-review section that will focus exclusively on clinical experience." Other AIDS journals focus more on research than clinical practice, notes Zuniga. This section "will try to draw out papers from clinicians and investigators who are not traditionally published, with a special emphasis on our HIV/AIDS-treating members in the developing world."
As part of IAPAC's commitment to fighting the global AIDS pandemic, it will establish regional offices to strengthen administrative support of new programs and to expand locally on IAPAC's advocacy messages. "Southern Africa is one of the regional epicenters of the pandemic," says Zuniga, "It makes sense to start there. We should conclude negotiations for a Johannesburg office later this summer." He foresees other IAPAC regional offices in Asia, Latin America, and Eastern and Western Europe.
God Bless the Child is IAPAC's most recent program initiative. Launched May 18, 2000, the pilot program forges a union with communities of faith in the United States to "adopt" a child living with HIV/AIDS in sub-Saharan Africa with a pledge of US$1000. Those pledges will be leveraged with antiviral drug donations for life from Bristol-Myers Squibb, and medical services (via an innovative clinical trial) delivered by the Princess Marina Hospital in Gaborone, Botswana, in collaboration with the Baylor International Pediatric AIDS Initiative in Houston, Texas, USA. The initial goal is to assist 500 Botswanan children.
"We all have the moral obligation to do whatever we can do, in a safe and effective way, to allow these children to have access to the healthcare that we take for granted in the North," observes Zuniga.
He carefully points out that IAPAC "does not advocate universal access to antiviral drugs" unless the necessary medical and social infrastructure is in place to support them. "Physicians kno w all too well that improper use of antiviral drugs is a prescription for the rapid evolution of drug-resistant virus. And that benefits nobody." To that end, IAPAC has launched a concerted effort to establish HIV medicine certification as a means to guarantee safe and optimal use of sophisticated AIDS therapies in resource-limited settings. IAPAC's international HIV medicine certification will be a voluntary process for physicians who wish to demonstrate proficiency in HIV clinical management.
"Whenever and wherever the credibility and responsibility of HIV treaters is measured, the objective third-party IAPAC certificate credential will serve as a reliable hallmark of competence," explains Zuniga.
Zuniga sees the North-South dialogue on AIDS as offering benefits for all participants. Nowhere is that more apparent than in clinical practice.
The number of new pediatric AIDS cases in the United States and Western Europe, never large, has become even smaller because of education and intervention. Likewise, combination therapy has greatly reduced the incidence of opportunistic infections, but it has not eliminated them.
That very success of the North at reducing the impact of HIV inhibits its ability to make further advances in these particular areas. The limited number of patients often is not sufficient to power multiple clinical trials for pediatric or OI patients. Physicians in the South unfortunately continue to see a large number of pediatric AIDS cases and a wide spectrum of OIs. They, therefore, can offer invaluable insights to the dialogue of clinical practice in treating these types of problems. They will be vital participants in developing and testing new therapies for and prophylactic agents against opportunistic infections.
Zuniga notes IAPAC is involving its members, both in the North and South, in exchange programs. Initially, that means using the Internet for Web conferencing and consultations. He wants to expand physical exchange programs on both sides of the equator. Some would be modeled on the US Peace Corp, others a more traditional residency program.
A week or two working in an African hospital would provide a wealth of clinical experience treating OIs for a US- or European-based physician. Such training would better prepare them to serve their patients at home when they contract opportunistic infections. "We have been very fortunate in gaining the foundation, corporate, and individual support necessary to initiate these relevant and sustainable new programs," says Zuniga. "The door is open, the hand outstretched for physicians and other healthcare professionals worldwide to join in these efforts to change the lives of others, and their own."
Bob Roehr is a medical writer based in Washington, DC (BobRoehr@aol.com).
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