The Global Plague of AIDS
New York Times (04/22/00)
Slowly and fitfully, political and financial leaders around the world are beginning to recognize the frightening dimensions and staggering costs of the global AIDS epidemic. This is a plague that threatens not just the lives of tens of millions, but the economic development and stability of vast regions.
In a potentially important announcement last week, the World Bank pledged to commit "unlimited money" to combat AIDS in poor countries. The lending bank's president, James D. Wolfensohn, declared: "We will make sure that no sensible program is stopped for lack of money. We will either provide it ourselves or we will help them raise it." Such a commitment could have a profound effect on the fight against AIDS by overcoming an acute lack of resources in the poorest and hardest-hit countries. The bank's promise is a challenge to political leaders in affected countries to take advantage of the offer.
By the end of 1999, more than 33 million people worldwide were living with H.I.V., the virus that causes AIDS, though the United Nations estimates that 90 percent of them are unaware of their infection. More than 16 million have died. Sub-Saharan Africa remains the worst off, with more than 23 million infected and 14 million dead. But new AIDS epidemics are emerging with exponential speed in Eastern and Central Europe, in India and China, and throughout Southeast Asia, Latin America and the Caribbean.
For many of these regions, AIDS is more than just a humanitarian problem. Because the disease is sexually transmitted, it is decimating not the elderly and infirm, but the most vibrant and economically productive sector of the population. In some countries in East and southern Africa, a quarter of the adult population is infected, with infection rates highest among skilled and semi-skilled workers, including doctors and nurses, teachers, engineers and civil servants.
In much of the developing world, treatment for the disease is negligible. Fewer than 10 percent of infected Africans are getting so much as an aspirin tablet to stem the ravages of tuberculosis, pneumonia and brain infections that accompany AIDS. There is still no cure and no vaccine for AIDS. The powerful drug cocktails that are prolonging lives among H.I.V.-positive people in developed countries can cost as much as $15,000 a year for a single patient. Pharmaceutical companies could help by reducing prices for the poorest regions, but even prices reduced by 90 percent would still be unaffordable for Africans whose annual income is counted in the hundreds of dollars.
The highest priority now is to arrest the alarming spread of the disease. The U.N. estimates it would cost between $1 billion and $2 billion a year to do an adequate job of prevention in developing countries. The U.N. and international lending agencies have already committed substantial sums to AIDS prevention, but current efforts are reaching only 10 to 20 percent of vulnerable populations. The United States has nearly doubled its own contribution to global AIDS prevention efforts, from $125 million per year over the last several years to $235 million this year. There is bipartison support in Congress for bills that would authorize $2 billion more over the next five years.
The increases are laudable, but they will not be sufficient. Currently, some 95 percent of all the AIDS prevention money is being spent in the industrialized countries, while 95 percent of those infected live in the developing countries.
There are some success stories that the world can learn from. Uganda, for example, has cut infection rates in half in recent years, through a combination of education, extensive testing and counseling, and condom promotion. Senegal has managed to contain the spread of the disease through sex education and condom promotion. Thailand has cut levels of infection by curtailing the sex trade.
But for every relative success story, there are far too many countries where urgently needed prevention and care have been blunted by denial, social stigma and a lack of political will. In South Africa, which has one of the highest infection rates in the world, 3.5 million people will die in the next decade. Yet earlier this year it was disclosed that $6.2 million of the country's $17 million AIDS budget went unspent last year. Regrettably, President Thabo Mbeki's government refuses to pay for distribution of the drug AZT to pregnant women, calling it too toxic, though AZT has been shown to reduce transmission of H.I.V. from pregnant mothers to their babies. Mr. Mbeki is also promoting the views of scientists who claim that H.I.V. does not cause AIDS, a discredited theory that could undercut efforts to stop the spread of the virus.
The World Bank and other international lending agencies can make money available for essential development of health care infrastructure in poor countries. But outside support will accomplish little unless the political will exists to confront this dread disease.