Public health officials and world leaders have attempted to describe the scale of the crisis numerous times. United Nations Secretary General Kofi Annan announced that AIDS is killing 5,000 Africans every day. Assistant Surgeon General David Satcher warned that if left unchecked, the HIV/AIDS epidemic "will kill more people than any of the terrible conflagrations that have marked this century." (JAMA 4/28/99)
Much has been said; little has been heard. With no prompting, Congress appropriated over $1 billion to help 750,000 Kosovoan refugees. In stark contrast it has taken months of demonstrations by ACT UP to get Vice President Gore and the Clinton administration to take a stand to support AIDS drugs for Africa. This huge political effort has only led to the possible addition of $100 million dollars to the $74 million already allocated to fighting HIV in Africa; enough to help one out of every thousand of the 20 million victims.
We know how to stop this epidemic. What is lacking is will, not knowledge.
A single dose of Nevirapine can prevent pregnant women from passing the disease on to their children. Yet over a million babies have HIV in Africa alone. Safe sex empowers individuals to protect their bodies, yet according to Zachie Achmont, member of the South African activist group Treatment Action Campaign (TAC), only seven condoms are distributed per sexually active person every year. Effective drug therapies reduce transmission and eradication to a crawl, yet virtually no one outside of Europe, Canada and the United States has access to any of them.
Recently Chatinkha Nkhoma, a 37-year-old HIV+ mother of a HIV-infected child from Malawi, made a statement before a congressional subcommittee. An International Affairs graduate from George Washington University, she paints an alarming image of life in a country ruled by AIDS:
"Traveling to America I discovered that there were new drugs which would allow me to live longer. These treatments meant that hope would be restored for people dying from AIDS. I have been unable to think of anything else except to see that these new wonder drugs are available everywhere for poor people dying with AIDS....
"Everyday I get messages from home about someone I know who died. My neighbors, work colleagues, friends, local entertainers, politician, many members of the cabinet and parliament are dying. In my family alone, I have lost my brother Mike, my sister Eleanor, three brother-in-laws, cousins, aunts and uncles....
"Allow us to have access to the treatment drugs so we can raise our children a little longer and not leave them as orphans. Orphaned children are turned into domestic and sex slaves. Prostitution is on the rise in an environment not usually conducive to this lifestyle. Hospitals are unable to cope with the large increase of patients. Morgues are operating 24 hours a day. Cemeteries are filling up fast. People are left hopeless, desperate and in total fear....
"I want to go home. To go home is to go to my death. To stay here and be silent is to suffer inside knowing millions of my people are sick with an illness your government has found ways to treat. We need access to these life saving drugs. This is the only way we can survive.
"Over 13 million Africans have already died. Over 20 million are dying. Over 20 percent will die every year without these life saving medicines. These medicines are necessities for life for those of us who are HIV positive....
"When the drugs are available, we the children of Africa, wherever we are, in America, Caribbean, Europe, Asia and Africa, will celebrate by singing and playing our drums and horns so loud you will hear us in this house. Mother Africa will begin to wipe away her tears, smiling, because Mother Earth will be waking up to stop her children from hurting everywhere. She will wake up and stop the CHAOS. Let the last couple of months of this horrible millennium be a positive beginning of the next millennium.
"This is the cry of the voiceless. The dying millions."
Three and a half million people died this past year of AIDS, and none of them had access to America's lifesaving medicines. Until recently, American officials have bullied Africa and other poor parts of the world to stop them from making or importing cheap versions of AIDS medicines (parallel importing/compulsory licensing).
As a result of pressure from HIV advocates in the USA, Vice President Gore is now attempting to find a settlement that will satisfy progressive voices in America and South Africa. This has led to suspension of a court suit led by American companies against South Africa attempting to stop South Africa from making and importing inexpensive medicines. It is the intention of Search for a Cure to join with many other organizations and call for Congressional Hearings here in Massachusetts to continue that pressure.
South Africa has stood firm in its intention to make and import cheap drugs legally in spite of U.S. pressure. Ian Roberts, who is a senior advisor to the Health Ministry in Africa, issued this statement on June 25th:
"It is the policy of the Government of South Africa that our people have access to affordable pharmaceuticals. Pharmaceuticals are an essential component of health care provision and all the people of South Africa now, in our new democracy, have a constitutional right to health care.
"Apartheid in South Africa resulted in gross inequalities in the provision of health in South Africa and in grossly distorted markets. For example, our pharmaceutical costs as a ratio of total health care costs, in South Africa, is double the U.S. ratio. So if people in the USA have a problem accessing medicines then, as can easily be predicted, the years of the apartheid government resulted in an even more serious situation in South Africa.
"To address inequality of health care provision, the new democratic government implemented a policy of free primary health care, including the free provision of pharmaceuticals to all patients attending government clinics. To ensure that the State could afford this correction, the Government of South Africa passed the Medicines Control Act. This Act broadly rectified the perverse incentives and market hazard the apartheid government had imposed on our country. The Act was approved by all government structures in South Africa and signed into law by President Mandela in December, 1997.
However, the multinational pharmaceutical companies, under the guise of protecting intellectual property rights, challenged this Act by starting legal action against the Government of South Africa including action against President Mandela. This legal action, however, is not restricted to matters of intellectual property but broadly attacks all of the transformational changes in medicines policy, that the new democratic government of South Africa needed to implement to reverse the ills of apartheid. As a result of this legal action many medicines still remain unaffordable to the majority of our people....
"Transformation is not easy in any country and is especially difficult in a developing country that needs to allocate resources not only to alleviate poverty but also to redress the evils of apartheid. South Africa needs the support of the American people and the U.S. Government in this process....
"In South Africa we estimate that 6.5 million people are now HIV positive. The cost of retrovirals means that they are unaffordable for our people. Even some of the medicines that are used to treat the complications of immune suppression are unaffordable, as are many medicines to treat other illness in our population. People in South Africa desperately need access to affordable medicines and it is the Government of South Africa's intention to ensure that this need is addressed."
Worldwide death from AIDS is the most important ethical event of the century. The widespread concern over the spread of the disease and the lack of medicines in developing countries is a reflection of the fact that we are rapidly becoming one world. Make no mistake about it: if we do not take actions to stop this disease now, it will mutate and sooner or later revisit us with versions that will be harder or, even worse, impossible to stop with our medicines. It will even have effects on our economy if we allow the economies of Asia, Africa, China and Russia to suffer dramatically from HIV. One African country has already told the World Bank that HIV has placed it in the position of choosing between saving the lives of people with HIV and paying back its loans.
Dr. Kenneth Mayer of Brown University, a world expert on HIV illness, said it best -- today there is no virus more than a day away by plane. And there is no country on earth that does not affect our stock market. So if there is not sufficient compassion to take immediate action, then at least let there be enough common sense.
(This Boston AIDS Writers Group panel consisted of David Scondras, Robert Krebs, Stuart Pynn, Jon Hultgren and Alysse Wurcel. The AIDS Writers Group is coordinated by Search for a Cure, a non-profit HIV Treatment and Education organization. If you have any questions or would like to receive the Reasons For Hope series in its entirety, you can contact Search for a Cure at 58 Burbank Street, Boston, MA 02115. They can also be reached by phone at 617-536-2474, by fax at 617-266-0051, or by email at firstname.lastname@example.org.)