E-drug: Origins of AIDS (cont'd)
-------------------------------------------------------------------------
[Crossposted from SIGNpost. With thanks. HH]
At risk of being labeled too candid or cynical, I wonder if others have
not also considered institutional and program behavior to explain
possible issues behind the current debate about the relative roles of
unsafe sex and unsafe injection in HIV/AIDS transmission. I don't
think we should tiptoe around a central problem that we face in many
public health programs.
Chronically under-funded public health agencies must constantly
search for funds to support their work. So they design and pursue an
investment strategy that is most likely to succeed in attracting the
needed resources. They calculate where the funds are and how best
to mobilize them. But an investment strategy is not always the same
as a balanced public health strategy.
In the 1980's, as now, there was insufficient recognition of or financial
interest in addressing the problem of unsafe injections. Among
Ministries of Health and their partners, the magnitude and burden of
unsafe injections was, and remains, an inherently unpopular reminder
about health system deficiencies which cause harm. To acknowledge
the problem is to own it, is to accept some responsibility for mobilizing
resources to solve it. While individual vertical attempts were made
(e.g., by EPI throughout the 1980s and 1990s) what was required,
and is still required, was a broader sector-wide approach to an
inherently "horizontal" problem.
In the 1980's, in light of the unavailability of funds to fix the problem of
unsafe injections versus the much greater availability of funding for
family planning, reproductive health, and STD control, it is likely that
the investment strategy of partner agencies determined what would
become their public health strategy. Possible avenues, such as
unsafe injection, might have prematurely been closed off in the
process. (When asked why he robbed banks, Willie Sutton said "that's
where the money is.")
The current debate over the relative role of unsafe injections in
HIV/AIDS transmission should be encouraged. In the meantime, the
debate has highlighted one of the uglier aspects of under-funded
public health programs - the competition for resources. The
international health community should be advocating for both safe sex
and safe injections. We must learn better to use limited funds to
achieve multiple parallel public health objectives.
Robert
Robert Steinglass
Immunization Team Leader, BASICS
1600 Wilson Blvd., Suite 300
Arlington, VA. 22209
USA
voice: 1-703-312-6800
fax: 1-703-312-6900
e-mail: rsteingl@basics.org
The three articles published on 20 February in International Journal of
STD & AIDS are:
- Mounting anomalies in the epidemiology of HIV in Africa: cry the
beloved paradigm http://www.rsm.ac.uk/new/std144intro.pdf
- Let it be sexual: how health care transmission of AIDS in Africa was
ignored http://www.rsm.ac.uk/new/std148main.pdf
- Heterosexual transmission of HIV in Africa: an empiric estimate
http://www.rsm.ac.uk/new/std162stats.pdf
The publication of the 3 articles was followed by a WHO/UNAIDS
meeting and this press release:
- Expert group stresses that unsafe sex is primary mode of
transmission of HIV in Africa.
http://www.who.int/mediacentre/statements/2003/statement5/en/
--
To send a message to E-Drug, write to: e-drug@usa.healthnet.org
To subscribe or unsubscribe, write to: majordomo@usa.healthnet.org
in the body of the message type: subscribe e-drug OR unsubscribe e-drug
To contact a person, send a message to: e-drug-help@usa.healthnet.org
Information and archives: http://www.essentialdrugs.org/edrug