May 29, 2008

The AIDS Crisis and The Invisible Cure

by Laura Starita

Advocacy, the availability of discounted anti-retroviral (ARVs) drugs and donations from Western governments and donors have made it possible for hundreds of thousands of people suffering from HIV/AIDS to get critical treatment which can prolong and improve the quality of their lives. In South Africa over the past 18 months alone the number of people receiving drug therapy has risen from less than 150,000 to nearly half a million, according to a recent article from Reuters. These are wonderful improvements. And yet making sure that everyone with HIV/AIDS gets treatment is a moving target, because infection rates are still shockingly high. While in South and East Africa infections among women who receive prenatal care (a problematic measure) seem to be stabilizing, it is estimated that in South Africa alone 1000 people are newly infected with HIV every day.

These statistics are at the center of a conflict that has been waging around the HIV/AIDS sector for over a decade. Namely, where funds should be concentrated: treating the sick; preventing new infections from taking place; or discovering a vaccine, which some still contend is the only true prevention effort, and which has been an elusive goal for nearly two decades. Most money today gets spent on treatment, for a number of reasons. The West completely ignored the AIDS crisis as it was unfolding in sub-Saharan Africa and other impoverished regions, and then the Clinton administration supported pharmaceutical companies in the mid-1990s as they pushed to keep ARV prices high, even for patients in developing nations. Such a late and inauspicious arrival at the game thus required some out-sized results to compensate. In this context, treatment is an appealing approach because it is easy to measure how many people received drugs and how morbidity and mortality rates changed as a result. In contrast, the West’s prevention approaches in Africa in particular have been downright dismal. This is true both of the offensive and stigmatizing condom distribution campaigns that began in the mid-1990s many of which sadly continue today, and of more recent abstinence-only initiatives.

The unfolding of the HIV/AIDS crisis in East and Southern Africa and the often damaging role that Western organizations have played in it is the subject of Helen Epstein’s book, The Invisible Cure: Africa, the West and the Fight Against AIDS. Philanthropy Action asked Dr. Epstein her views of current treatment and prevention programs in Africa and how Western money can do better work for the African AIDS crisis.