Richard Laing Co-Moderator wrote:
As E-DRUG readers will know from previous messages, I have strong
beliefs about this topic. In summary, I believe that for low
prevelence countries the cost of screening pregnant women prior to
AZT treatment is too high.
No disagreement here. But what about those pregnant women already
diagnosed? And if we can offer a hope of reduced probability that the
baby will be born infected, may we not persuade pregnant women who
feel that they may have been at risk of infection to volunteer for
testing?
For high prevalence countries the cost of the prophylactic AZT
treatment will be excessive. For AIDS patients the costs and
benefits are not in balance when diseases such as TB and STD's are
not being treated adequately.
As a general taxpayer, I might agree. As an 'AIDS patient', I would
probably be more concerned about my AIDS than my potential for TB or
STDs.
But I do agree, as I said in my post, that much more attention
_must_ be placed upon diagnosis and treatment of STDs. I'd probably
also add Dengue Fever and Malaria to TB.
But the fact is that if we balance a budget of less than $5 per
capita per year, we will probably treat very little. Decisions do
have to be taken to allocate more resources to one problem than
another. We'll all have our own preferences for how this should be
done. For me, preventing AIDS in an unborn infant seems to me a
worthwhile objective, and one that can be at least partially
addressed with some creative fund-raising. Dr. Paul Wangai's original
post questioned the wisdom of the UNAIDS program to provide HAART to
around 10,000 people in four developing countries. UNAIDS will
contribute $1 million to this, and my calculation is that drug
companies will contribute (at least in kind) many times that (10,000
people times $15,000 per month for HAART times 12 for a year comes to
what?) In my view, this contribution could be _much_ better spent on
prevention of vertical transmission--how may births at $80 would
that cover?.
I think that Paul's original comment that we should be looking more
broadly at this topic are very useful. I believe that in African
countries at least major social, behavioral and political changes
will be needed to reduce the epidemic.
Again, no disagreement from me. But I'm sure you do not underestimate
the time and effort needed to make such broad-reaching changes...
Uganda has shown the way. For the past five years the number of new
cases and the HIV prevelence has fallen. So it can be done!
There's two different statistics here. Yes, I accept that the number
of new cases has dropped in several societies. To what extend is this
due to the fact that most of the susceptible population are
already infected? New cases inevitably drop off then. HIV prevalence
has fallen? Maybe, but not at the rate that new cases have.
Chris
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Chris W. Green (chrisg@rad.net.id)
Jakarta, Indonesia
Tel: +62-21 846-3029 Fax: +62-21 846-1247
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