I just read a chilling article in the New York Times about our prospects in the fight against HIV/AIDS. They’re not good.
During the past 10 years we turned a corner. Cheap medications became widely available, and millions of people worldwide began receiving treatment. Before 2005, getting HIV was a death sentence for the majority worldwide, including more than 2 million children newly infected annually. Then there was hope. But will this hope be sustained, or are we turning a corner in the opposite direction?
…for most of Africa and scattered other countries like Haiti, Guyana and Cambodia, it seems inevitable that the 1990s will return: walking skeletons in the villages, stacks of bodies in morgues, mountains of newly turned earth in cemeteries.
What happened?
Simply put, the number of newly infected people each year is exceeding the number we can treat. At the same time, funds for the fight are shrinking. Besides the global economic crisis, donors have been redirecting funds to combat malaria and other preventable diseases that actually kill more people than HIV/AIDS.
It would be a terrible tragedy to return to the situation ten years ago when people were dying in such numbers and unimaginable conditions. I’ll be moving to Cambodia in two months, and I know children who are alive because they take ARV medications every day. When those programs started, promises were made that the plug would never be pulled. You can’t give someone medicine and then take it away after a few years…can you?
The bitter truth is that we cannot save everyone. We’re slowly saving less and less. We must concentrate more on prevention, or the dam will break.
“You cannot mop the floor when the tap is still running on it,” said Dr. David Kihumuro Apuuli, director-general of the Uganda AIDS Commission.
There are no easy answers. Prevention versus treatment is more than just a debate to take sides in. Simply giving more money is not an answer. I recommend reading the full New York Times piece and Bill Easterly’s response for further perspective.
Living with HIV in Cambodia thanks to ARV medications provided by USAID funds
Hello Andy, prevention sounds great, but how?
I mean, prevention programs fail even here… “in developed world” that is USA and Canada. How do you minimize the spread of the virus in countries like Cambodia? I mean… you can educate people, help them with medication (lets assume you have the funds), family planning, free contraception, etc. but you cannot expect that every single HIV/AIDS positive person is goodhearted and caring. I think, this is were the government has to come-in and take things under control (legally protect healthy citizens rich and poor alike). Is their government doing anything about this problem? Do they care enough to stop HIV from spreading?
As you say, it’s impossible to entirely prevent the spread of HIV/AIDS. So far, the main tactic has been to stop new infections at the most common sources: prostitutes and shared needles.
Prostitutes are educated about HIV and then given free condoms. Drug users are educated and given free needles. In some areas, the majority of prostitutes are infected, in other places the majority are not infected.
It might seem ideal to stop prostitution and drug use, but that’s not realistic. In restrictive societies both are simply driven underground. Of course, if morality standards change over time, then prostitution and drug use will decrease, and that will prevent the spread of HIV/AIDS. I think it’s best to think holistically and not limit tactics to one dimension of the problem.
As for controlling people, historically speaking that’s very difficult. You speak of “legally protecting healthy citizens.” What does that mean? Remember, it’s the healthy citizens who engage and risky behavior and get infected. Also, keep in mind that 80 percent of infected people don’t even know they’re infected.
Perhaps we should require 100 percent of people to get tested for HIV and then quarantine all the infected people? That MIGHT work in some countries where 1 percent of the population has HIV (but imagine quarantining more than 1 million people in the USA for the rest of their lives…). It won’t work in countries where 20-40 percent of the people have HIV.
Andy – Have you read the book: “Enough – Why the World’s Poorest Starve in an Age of Plenty?” It deals with this issue specifically (as with many others). I can’t recommend it highly enough. It’s easily the most explosive book I’ve read in a long time, and I read a lot. You would love it (and find it infuriating at the same time). Anyway, perhaps you’ve already read it. If not, get it and read it! I’d love to know your thoughts on it.
Mike – It looks like a good book, and I added it to my (very long) wish list at Amazon. I don’t know if I’ll buy any books in the next few months, but eventually I’ll start reading through the list again (maybe when the prices of ereaders and digital books gets down to $50/$5).
hi michael, seems like a good book to me. thanks for introducing it. will check it out….
Since childhood we are taught that prevention is better than cure so why don’t we apply it with sex?