Thursday, May 31, 2012

HIV/AIDS: The First Step Is Admitting It

While no one has found a cure for AIDS, there are scientifically validated preventative and palliative treatments for it. Antiretroviral therapy (ART) significantly delays the onset of AIDS in people living with HIV and prevents HIV+ pregnant or breastfeeding women from passing the disease onto their children. Contraceptives greatly reduce the chances of transmission during intercourse, and infant circumcision has a similar effect in the long term. These interventions work. We know that.

Part of the problem in scaling them up in AIDS-ravaged countries, however, is cultural and political denial, a blank refusal on the part of societies and, less often, governments to acknowledge the severity or even existence of the HIV/AIDS crises. Unfortunately, because HIV spreads through sex, something very private, and then lays dormant for years after transmission, it is easier to reject the causal link between HIV and AIDS. Moreover, because AIDS destroys the immune system but does not finish its victims off, denialists try to attribute deaths from AIDS to tuberculosis or other common diseases, which set in with ease after AIDS has removed the body of its defenses.

For an example of a government’s refusal to accept HIV as a cause of death, take the South African government pre-2009. Though the AFCA does not happen to work in South Africa, in the 2000s President Thabo Mbeki took to the extreme a pattern of denial that persists on a smaller and somewhat tamer scale elsewhere in Africa, including in the four countries in which we work. In South Africa, despite the near doubling of children’s AIDS prevalence between 2001 and 2007, the 7.7% increase of the prevalence rate during the same period, and more AIDS cases than in any other country but India, Mbeki consistently renounced the link between HIV and AIDS. Spurning civil society groups such as the impassioned Treatment Action Commission, he refused to spend government funds on ART, maintaining that the medicine was a waste. One Harvard study concluded that his negligence cost South Africa 300,000 lives.

In 2009, things changed abruptly. Anti-AIDS campaigner Jacob Zuma won the South African presidency, reversing Mbeki’s policies soon thereafter.  Zuma actively and publicly sought to reduce the incidence of HIV. His efforts paid off. By 2011, 95% of HIV+ pregnant women were taking ART pills, preventing mother-to-child transmission. Moreover, Zuma’s government lowered the requirements for receiving ART—a moderate CD4 count (a measure of immune-system strength) of 350 rather than 200, at which point the prospective patient is already suffering in the clutches of the disease. Despite these changes, the tide of transmission still outweighs the government’s efforts. Prevalence rates continue to climb, but at a slower rate (3%) than during Mbeki’s presidency. In restricting, but not stopping, the spread of HIV, the South African government has saved many, many lives.

Obviously, as the case of South Africa demonstrates, lack of willingness on the part of African leaders to face AIDS does not fully explain why the disease persists. Another large part of the problem lies in the fact that, though the price of ARV has dropped in the last decade in response to loosening patent monopolies on the medicine, African governments seldom have the funds to provide treatment for all who need it. South Africa is by far the wealthiest country in Africa, and, even after election of Zuma, it still has not achieved full coverage. Nevertheless, denial is an important facet of this extraordinarily complex global health crisis. To understand why AIDS persists, we must understand why in some settings it goes unacknowledged and how we can work to encourage openness and educate Africans (and ourselves!!!) about this very real threat.

World Health Organization Statistics

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