AIDS in Africa has reached such catastrophic levels that analogies to past wars or plagues no longer drive home the present-day urgency. AIDS on the continent is not only affecting so many, but even more catastrophic, of course, is that adequate care and treatment for HIV infection is essentially nonexistent in most African settings. This is not a time for business-as-usual.

The recent announcement by five major pharmaceutical companies, with brokering from the UNAIDS and WHO, to dramatically lower the price of antiretroviral medications to African markets should be applauded as a significant step away from business-as-usual, and one toward helping solve this catastrophe. Unfortunately, the move toward lower costs for expensive medications is only one piece of the puzzle of how to care for the greater than 23 million Africans presently living and dying with HIV. Even if all the antiretroviral medications were free of charge, only a few thousand of the millions of infected and yet-to-be infected would safely benefit. Let us review the scenario.

First, most estimate that the vast majority of Africans living with HIV infection--most likely much more than 90 percent--do not even know they are infected with HIV. Routine testing and counseling for HIV infection is rarely, if ever, available in most regions of Africa. Moreover, the stigma of being identified as having HIV infection is so negative that in many situations, people avoid HIV testing and counseling even when it is freely available.

Second, even assuming that HIV counseling and testing were widely available and utilized, in many areas of Africa basic medical care is scant. Large investments to increase training of personnel, to improve infrastructure to deliver services and to insure sustainable improvements would be needed to provide the basic medical needs of those newly identified HIV patients, let alone the existing urgent, basic health needs of all Africans. Third, assuming that basic medical care was available, providing what might be called "HIV case management" in healthcare settings in the West would require additional trained personnel, resources and medical infrastructure to create the long-term clinical follow-up needed to treat this chronic infection. Other diagnostics and medications would be needed for both the treatable and the preventable infections that occur with HIV infection, prior to consideration of antiretroviral therapy. In addition, sophisticated (and expensive) laboratory and technical support would be necessary to medically manage HIV infection, prior to the use of combination antiretrovirals.

Unfortunately, this dramatic African scenario is well known. Yet, if this tragic puzzle seems unsolvable, now comes the hard part. If we are going to help solve the problem of the lack of treatment for AIDS in Africa, first we are going to have to start treating Africa differently. That is, we need to finally treat Africa as part of the world community. For those of us in the West, Africans and the plagues of Africa are either too far away, too unsolvable, or too unlike our own problems (or skin) to be of serious concern to us. Let me be blunt while I'm on this soapbox. Neither isolationism, nor western-based approaches nor hidden racism has a place in our needed new approach to Africa.

In our new approach, both Africans and non-Africans must define ones "tribe" as larger than we have historically or genetically done so in the past. Those of us with the means to think large in today's growing global economy are even more obligated to do so. Our present response to AIDS in Africa is a moral embarrassment. Rising above business-as-usual concerning AIDS in Africa is needed not because AIDS is a security threat to the West, not because an election is around the corner and not because public pressure impacts the marketplace. AIDS in Africa needs our concern because it is the right thing to do.

Furthermore, more non-Africans and Africans need to become true leaders--to be part of the solution. True leadership anywhere usually means not taking the easy road nor the popular stance. When Africans have led and have taken ownership of their local epidemic, successful interventions have occurred and collaboration with Western funders has usually increased. The reason our new approach to Africa is the hardest part of the puzzle is that solutions will need long-term commitments from all sectors of society--not just the pharmaceutical industry--to sustain the kind of coordinated, intense effort needed to bring this wonderful continent into the basic state of health enjoyed by so much of the world. We share a common problem: a viral epidemic of Biblical proportions both in the West and Africa. Let us create this new approach together. Our lasting solutions will not be found just in the price of drugs; that is only part of the problem.

Our lasting solutions are multifaceted, will need to involve us all and will require both work and money. We can improve the care and treatment for the millions living with HIV, but first this means digging deep in our hearts, not just our pocketbooks, and taking Africa seriously.

Richard Marlink, MD, Editor-in-Chief of JIAPAC, is the Executive and Senior Research Director of the Harvard AIDS Institute. Dr. Marlink has provided clinical, laboratory and research support for collaborative efforts in Africa related to HIV and AIDS since 1984.

000710
IA000705

Copyright © 2000 - International Association of Physicians in AIDS Care. All rights reserved. http://www.iapac.org

ÆGiS is made possible through unrestricted grants from Roxane Laboratories, Inc., iMetrikus, Inc., the National Library of Medicine, and donations from users like you. Always watch for outdated information. This article first appeared in 2000. This material is designed to support, not replace, the relationship that exists between you and your doctor.

ÆGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1990, 2000. ÆGiS & the Sisters of Saint Elizabeth of Hungary. All materials appearing on ÆGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of ÆGIS and the Sisters of Saint. Elizabeth of Hungary, or the party credited as the provider of the content.