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AIDS Out of Focus?

By José M. Zuniga

October 2004

Jose M. Zuniga
What does it take to focus attention these days? Events come and go, an endless barrage of images in the media. There has hardly been time to digest and comprehend what we have just seen before something new comes along, and everything that seemed important is all but forgotten, or at the very least placed on the back burner.

I should beware, of course, of overgeneralization. For an African mother who is dying of AIDS-related complications, who has barely enough food to offer her children, let alone antiretroviral medication for herself or them, the "problem" of information overload does not exist. The distinction between the important and the trivial is a clear one for her, desperation having the effect of focusing one's mind.

It is, instead, those of us living in the wealthy countries of the global North who are easily driven to distraction. In the United States, as I write this, we are in the middle of a presidential election campaign, and among the items dominating the broadcast media is discussion of which candidate's campaign team is doing a better job convincing the citizens of "middle America" that their man is of the people.

At the same time, we are gearing up for holiday shopping and reading economic uncertainty in the toy industry's re-evaluation of their expected sales. There are interesting new television shows to watch. There is a new sex scandal to follow.

And we cannot help but be drawn in when we witness the Boston Red Sox defeat the New York Yankees, finally, after nearly a century, overcoming their "curse" on the way to the (so-called) World Series. You have no interest in baseball? Relax. In another week, there will be an entirely different set of news stories.

Meanwhile, AIDS continues its march around the globe, steadily traversing the path that has been predicted for years. In another sign that the epicenter of the pandemic is moving east, into the densely populated countries of Asia, epidemiological experts are now estimating that India has overtaken South Africa as the nation with the most people living with HIV/AIDS.

From one perspective, this is all happening very quickly. At the current rate, AIDS may well take 70 million lives in just the next 15 years -- cementing it as the worst pandemic in recorded history. However, from the perspective of many of the people whose political will is required to launch an effective, long-term response to HIV/AIDS -- those, that is, who are living amidst the media saturation of the world's wealthiest nations -- it is all happening in near slow motion. In another example of the inequality that contributes to the spread and lethality of HIV disease, those who have the power to act are the least likely to see, and remain focused upon, what must be done. By contrast, those whose very lives are in the balance have, by accident of a geographic and sociopolitical lottery, almost no power to effect change.

Lest this entire Report from the President be devoted to pessimism and challenges, however, I think that last fact can help point the best way forward. In a word, we need to find ways to put power in the hands of individuals and countries who are most affected by HIV/AIDS. Relying on the altruism of others is necessary in the short term, but it will ultimately be untenable.

In practice, this means governments should be encouraged to guarantee healthcare as a human right, giving citizens the power to demand it and hold politicians accountable when it is denied them. It means that every initiative meant to scale up antiretroviral therapy must be self-sustaining. It means that even as we are working to reduce the price of antiretroviral drugs we should be plugging the brain drain and making plans to alleviate unsustainable physician:patient ratios in developing world countries. It means empowering local physicians and allied healthcare professionals with the knowledge they need to treat HIV/AIDS themselves.

So, what does it take to focus attention these days? Perhaps that is the wrong question. The millions who are living with and dying of HIV/AIDS in the developing world have already had their attention focused. It is rather our job to give them the power to do something about their own destinies.

José M. Zuniga is President/CEO of the International Association of Physicians in AIDS Care (IAPAC), and Editor-in-Chief of the IAPAC Monthly.

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