E-DRUG: cheaper drugs and behaviour change
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[crossposted from Pharm-Policy with thanks. NN]
http://www.nytimes.com/2001/04/27/opinion/27FRIE.html
It Takes a Village
By THOMAS L. FRIEDMAN
New York Times
April 27, 2001
ACCRA, Ghana -- When you read the statistics about AIDS infection in
Africa, they are so staggering as to seem unbelievable. More than 25
million Africans are now living with H.I.V., the virus that causes AIDS.
Last year alone, 2.4 million Africans died from the disease, and it is
expected to claim the lives of about half of all 15-year-olds. More than
35 percent of all adults in Botswana are H.I.V.-infected. Throughout
Southern Africa, you can now find villages populated only by young
people and grandparents, with the whole middle population killed off by
AIDS, creating a huge orphan problem.
What to do? Lately, much attention has been focused on the effort to
pressure global drug companies to take steps to bring down the prices of
their anti-retroviral drugs � from $16,000 to $300 per year � which
would allow Africans afflicted with H.I.V. to live meaningful lives.
Lord knows, anything that will alleviate the suffering of Africa's
destitute H.I.V.-AIDS victims should be supported. But African AIDS
experts are getting worried that all this focus on drug companies and
cocktails to make living with AIDS tolerable is diverting attention from
the real issue � stemming the spread of the disease.
"It's not the drug cocktails that are going to enable us to overcome
this major, major social problem," says Dr. Fred Sai, Ghana's top AIDS
expert. "It can only be done by education, preventive health measures
and creating better living standards. I am afraid that the big U.N.
conference on AIDS in June is going to get hijacked by this clamor for
drugs, drugs, drugs, when the answer is prevention and building better
societies."
What good is a $300 anti-retroviral package to a villager in Ghana with
AIDS when Ghana's per-capita income is $350? More important, how are the
drugs going to be effectively distributed?
"Virtually all African countries have centralized government drug import
and distribution centers, and most of them are broken or corrupted,"
says Dr. Josef Decosas, director of the Southern Africa AIDS Training
Program. "Even if you make these drugs available for free, the systems
to deliver them are not there. Of course we should get the prices down,
if only 50 people benefit. But this is not going to make any difference
and probably is going to cause distortions to the already struggling
African health systems, by forcing in a new technology when they can't
even distribute treatments for tuberculosis, which cost $1 a month.
H.I.V. in Africa is contracted and spread through a web of causations �
economic, developmental, social � and when you start focusing on a
single solution, like anti-retrovirals, you fail."
Indeed, what is scary is that as devastating as AIDS has become in
Africa, many Africans remain either uneducated about how H.I.V. is
spread or simply do not believe they'll be infected. In Africa,
prostitutes know that condoms should be used, but they'll often let men
have unprotected sex for double the price. Without any economic
opportunities, young women throughout Africa have to sell their bodies
for food or simply lack the power to negotiate sexual relations with
older men or husbands.
Why did H.I.V. infection in Senegal plateau at 1.5 percent of adults,
while Zimbabwe has 25 percent infected? Surely one reason, says Dr.
Decosas, is that Senegal has strong civil society and community
institutions that have produced a web of home-grown self- help
responses. These range from peer groups of women educating other women,
to families and villages coming together to take care of AIDS orphans,
to widespread education about condom use in every dialect. Last year
Ghana began a U.S.-funded ad campaign to promote condom use, based on a
local ditty that goes: "If it's not on, it's not in." The campaign
employed local street theaters and rap stars, and after six months
condom use had risen by 80 percent.
It was gay men in San Francisco, helping and educating other gay men
infected by H.I.V.-AIDS, who brought the epidemic under control in their
community, not the government, notes Dr. Decosas. It takes a village.
Indeed, there is a Ghanaian proverb that says: "The tortoise knows how
to make love to his wife." It means: You haven't even thought about the
problem, but the tortoise has already figured out the solution himself.
That is also true about AIDS in Africa. "They have found a lot of things
that work themselves," said Dr. Decosas, "and if we can focus our
efforts on strengthening those things we will be a lot more effective at
combating this disease."
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