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The Politics of Africa's Pain

September/October 2002

A note from The field of medicine is constantly evolving. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!

The XIV International AIDS Conference

More than 38 million of the world's 40 million people living with AIDS have no access to medical treatment -- an immense catastrophe caused by the political and moral bankruptcy of wealthy nations, said AIDS treatment advocates gathered at the XIV International AIDS Conference in Barcelona.

Treatment activists and experts, convening a special session on the day before the opening of the conference, charged the U.S. and other Western countries with gross and willful neglect, if not criminal behavior, for their ineffective response to the global crisis of HIV/AIDS, the leading cause of death in Africa.

"If I as a doctor ignore a sick person in desperate need of care, I am committing medical malpractice, and can be charged with a crime," said Dr. Morten Rostrup, head of Médicins Sans Frontières (MSF), a humanitarian medical aid agency with operations in more than 80 countries.

"Today and every day, more than 8,000 people with AIDS will die," warned Rostrup. "Yet the international community refuses to mount and fund an adequate global response -- we are faced with nothing less than a crime against humanity."

Currently, of the 40 million people living with AIDS worldwide, about 730,000 people are receiving antiretroviral treatment -- 500,000 of whom live in high-income countries. In sub-Saharan Africa, where 2.2 million people died of AIDS last year, only 30,000 people received treatment.

Since their discovery in the mid 1990's, antiretroviral (ARV) drugs have proven highly effective at combating the voracious growth of HIV within the human body. The virus attacks and destroys the body's natural immune system, making it susceptible to a legion of opportunistic infections. When unchecked by medication, the virus replicates with a fury, producing 10 billion copies each day.

Effective antiretroviral therapy not only directly benefits people living with AIDS, but also reduces the staggering social and economic impact of the epidemic in poorer countries. Yet, despite continued advances in AIDS medications, these drugs remain out of reach for the vast majority of HIV-infected people in the developing world.

Treatment advocates claim that the most obstinate barriers to accessing medication are caused by the dubious political will of affluent wealthy countries. For example, major pharmaceutical corporations, who largely control the world's treasure chest of ARV medications, seem wholly out of step with the global pandemic. Claiming the need to protect their investments, drug companies have held their medicinal formulas under lock and key, making it difficult if not impossible for poorer countries to manufacture or import generic versions of patented drugs.

According to the Health Global Access Project (Health GAP), despite some recent slacking in the tight corporate grip on AIDS meds, patents block generic replication of at least four ARV drugs in 27 African countries and at least one ARV in another 31 countries.

It has also not gone unnoticed by treatment activists that the pharmaceutical industry spends $13 billon per year marketing their wares directly to doctors -- more than the estimated cost of arresting the spread of AIDS globally. Advocates claim that the free market-driven system encourages investment in treatments of conditions like male baldness rather than HIV/AIDS.

Some Western experts, however, have claimed that even if a bottomless pot of funding were available for AIDS drugs in Africa and other developing countries, treatment would not be feasible in resource-poor settings. These experts argue that poorer countries lack the medical infrastructure to support ARV regimens.

Last year, Dr. Anthony Fauci, a National Institutes of Health infectious disease chief and one of Bush's key advisors on HIV/AIDS policy, stated that an adequate healthcare infrastructure that would support the use of ARV drugs in developing countries "just doesn't exist right now."

But treatment advocates at Barcelona flatly disagreed and brought their evidence in hand. "The feasibility of treatment has never been more certain," said Alan Berkman, founder of Health GAP, who joined colleagues from MSF to present a study on seven African nations that have successfully implemented ARV programs in resource-poor settings.

MSF researchers presented data at the conference from seven ARV pilot projects in developing countries including Cameroon, Kenya, Malawi, and South Africa. The data showed that providing effective treatment in resource-poor settings has concrete clinical benefits and dramatically improves the quality of life for individuals and families.

Patients in the seven observational projects entered treatment programs in advanced stages of AIDS and were treated with ARV therapy in local health clinics in poor townships, rural areas, and outpatient units at district hospitals.

After six months, over 80 percent of patients showed undetectable levels of virus in their blood, and researchers reported that patient compliance was impressive, with 95 percent of patients taking their treatment properly at six months.

"There are some people who say that in Africa people will not be able to take these drugs because they cannot tell time," said Fred Minandi, an HIV-positive farmer from Malawi who has a wife and two children -- invoking the now infamous statement of Bush U.S. Agency for International Development chief Andrew Natsios. "I may not have a watch, but I can assure you that since I started taking my triple therapy in August last year, I haven't missed one dose."

Minandi, who lives in the Chiradzulu district, is one of the first patients to get free medications through the MSF project that began in Malawi in 2001. An estimated 800,000 people in Malawi are living with HIV/AIDS.

Treatment advocates argue that one of the most formidable barriers -- and telling deficiencies -- to scaling up the availability of AIDS drugs is the failure of wealthy nations to mobilize promised resources for the Global Fund to Fight AIDS, TB and Malaria and other financing mechanisms. Donor nations have abandoned their responsibility, say advocates, and repeatedly broken promises made over the last two years by pledging only 8 percent of the estimated funding necessary to fuel an effective global response to the AIDS pandemic.

Advocates say that the U.S. set the donor bar extremely low by initially offering only $200 million, less than 10 percent of what many experts believed should have been offered by a country commanding the world's largest economy.

"The United States alone should provide $1 billion at least for starters," declared U.S. Representative Barbara Lee to a crowd of around 1,500 activists gathered at a treatment access rally in Barcelona. "And then the entire world must step up to the plate."

The heavily burdened resources of the Global Fund were designed to be split between HIV/AIDS, malaria, and tuberculosis. Moreover, funds allocated for AIDS must be spread across multiple programs for treatment, prevention, and care, leading many advocates to question whether the fund was designed as a formula for success or for failure.

"What we learned on September 11 is that in a few weeks it's possible to mobilize a massive political and financial response to a perceived common threat," said Rostrup, who recently returned from an ARV treatment project in Nairobi, Kenya. But when it comes to AIDS in Africa, said Rostrup, "There is clearly a problem of political will."

"The AIDS crisis is about political will and moral will," added Berkman, who believes that the pandemic has escalated "from a tragedy to a crime."

He also believes that the Western obligation for funding might best be understood in the historical light of reparations owed to Africa for colonization and to African Americans for slavery. "The U.S. can say that we don't owe reparations but we do," said Berkman. "The disrespect for African lives that we are witnessing in the AIDS pandemic and in various other forms is deeply rooted in the racial patterns in colonialism, slavery, and American society."

John Price is a health reporter for the New York Amsterdam News. His work has also appeared in numerous publications including the New York Daily Journal, Quarterly Black Review, Tennessee Tribune, and the Milwaukee Courier. His work has also appeared online at and Price was recently awarded the Kaiser Media Fellowship in Health for 2002. Reprinted courtesy of

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A note from The field of medicine is constantly evolving. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!

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This article was provided by Positively Aware. It is a part of the publication Positively Aware. Visit Positively Aware's website to find out more about the publication.
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More Background on HIV Policy and Funding for the Developing World