Aug 08, 2006

HIV & AIDS: The South African Case

by Laura Starita

What happens when a drug exists and is available in sufficient quantities at no or low cost but the patient won’t take it? This is the question addressed in Tina Rosenberg’s New York Times Magazine article on the HIV/AIDS crisis in South Africa.

In South Africa, 18.8 percent of adults are HIV-positive. While infection rates in comparable countries have held steady or even declined, South Africa’s is rising. Because of social stigma, many South African adults do not take an HIV test, those who do often fail to get the results and those who learn they’ve tested positive often refuse antiretroviral treatments. Rosenberg shows that fighting the epidemic requires social, cultural and behavioral changes.

Rosenberg profiles loveLife, a South African program focusing on teens and young adults as a social aid to battling the epidemic. LoveLife showed some anecdotal success and teen infection rates have decreased (though it is unclear whether loveLife programs are the cause). However, the article doesn’t address an obvious question, what are other countries with successful epidemic containment programs doing that can be leveraged in South Africa? Uganda, Zimbabwe and Kenya, among others, have taken the ABC (Abstain, Be faithful, use Condoms) approach to changing behaviors and married it with programs to reduce social stigma. In each of these countries, there have been marked reductions in HIV-infection rates. Why aren’t these countries being analyzed in view of South Africa’s crisis?

Most troubling for its inaccuracy is a statement near the end of the article:

Across Africa, groups are turning to abstinence-only programs not because they work - they don’t - but because that’s what Washington wants to finance. Rigorous evaluation to show which AIDS programs are effective is also necessary, something that is only an occasional afterthought today.

Washington’s PEPFAR (the President’s Emergency Plan for AIDS Relief) stipulates an even distribution of funding across A, B and C for prevention initiatives, not just abstinence as Rosenberg asserts. While one may with cause argue that it is arbitrary to require in all contexts a stipulated percentage of funds for abstinence (or anything else for that matter), but saying that PEPFAR will only fund abstinence is false. The Bush administration doesn’t always apply the best thought to its public policy decisions, but this case is not as extreme as Rosenberg (and many others) make it sound. The ABC approach—and particularly the “be Faithful” part on account of its impact on partner reduction—has has been shown, through the ‘rigorous evaluation’ processes Rosenberg advocates, to be the only effective way of driving down HIV-infection rates.

PEPFAR supports faith-based approaches. Another recent report, this one from Tearfund, a large United Kingdom-based Christian charitable organization, notes the positive results churches in sub-Saharan Africa are generating. In many regions in Africa, faith-based groups make the strongest social networks in a community, positioning them to provide counseling, education, nursing services and bereavement support. According to Tearfund, the value of church-based action on HIV and AIDS in terms of volunteer hours is $4.4 billion, roughly equivalent to what The Global Fund has spent over the last two years. Tearfund advocates more attention be paid to these cost-effective programs so they can be strengthened and have even greater impact.

New York Times Magazine: http://www.nytimes.com/2006/08/06/magazine/06aids.html?pagewanted=1 “ target="_blank">When a Pill is Not Enough

TearFund: Faith Untapped