NEW YORK — World AIDS day traditionally has become an occasion for reciting statistics of a plague so overwhelming it remains beyond comprehension. Just one example: 3 million die a year—an average of 5.7 every minute of every day. But there was one AIDS day that was different and it was just two years ago.
Around that time, the World Health Organization announced an ambitious plan called “three by five” to get three million people in poor countries on the effective anti-viral medications that have saved many lives in the U.S. and other wealthy countries by the end of 2005. President Bush announced that the U.S. would spend $15 billion over five years to combat AIDS in the developing world. And something called the Global Fund for Fighting AIDS, Tuberculosis and Malaria said it too would spend billions for effective AIDS therapy.
Until then most international health experts agreed that treatment with effective anti-viral drugs for poor countries was simply impossible. For one, the cost was astronomical and would drain funds that could be used to fight other deadly diseases in these areas, such as malaria and tuberculosis. For another, anti-retroviral drugs control the virus but don't cure it, so providing them represents a long-term commitment.
Doctors worried about the logistics of administering complex medications in places with ramshackle roads, inadequate hygiene, and no running water. What if people missed doses, allowing drug-resistant forms of the virus to emerge? Experts also worried that if people believed there was an effective treatment for AIDS, then prevention efforts would fail.
The result was the infected poor watched while the infected wealthy survive.
But an amazing coalition of activists, bureaucrats and politicians from rich and poor countries, the United Nations, academics and several non-governmental groups—most notably Ralph Nader's Consumer Project on Technology, Médicins Sans Frontières, President Clinton’s Global Initiative and Act Up—brought critical changes.
The annual cost of the medications fell from more than $10,000 to less than $150. Numerous demonstration projects showed that the treatments could be effective in those surroundings. Countries pledged money for the effort and two years ago it seemed like true progress was possible.
Return to horrible statistics
But the story of this year’s World AIDS day is again failure. The World Health Organization says that only one million people in poor countries are getting the drugs out of the six million who will surely die soon without them. And even the one million figure is an exaggeration. Fully 300,000 are in Brazil, a relatively wealthy country that manufactures its own AIDS medication and is one of the only nations of the developing world to truly confront and conquer its AIDS threat. The cause for the failure is almost due to shortfalls in the financial commitments, and not just by the United States. The Tsunami, Katrina, the Pakistani earthquake and other catastrophes diverted the world’s attention from AIDS.
So, for World AIDS Day 2005 we can return to the horrible statistics: 40 million currently infected and massive epidemics preparing to erupt in India, China, and Russia with little apparent concern for prevention methods that could stop the unfolding disaster.
And let us not think that failure with respect to AIDS occurs in only other countries.
We are approaching the twenty fifth year of the AIDS epidemic in the U.S. The drugs brought a 70 per cent decline in the death rate in the this country from their discovery in the early 1990s to the mid-1990s. But they are not a cure and eventually they stop working. In this country, 14,000 people a year still die from AIDS and that number has not changed since 1998. Health officials estimate that 40,000 Americans still get infected every year.
Video: World AIDS Day Some well known prevention strategies could lower that number—public education, condom use, clean needles and syringes and more widespread testing for infection with the AIDS virus. An old fashioned public health method where people who are infected are identified and their sexual partners are contacted anonymously could also lower the infection rate. But as New York City Health Commissioner Thomas Frieden and his colleagues write in the current New England Journal of Medicine “religious and political groups oppose the use of effective prevention measures” while “some advocacy groups oppose” contact tracing and widespread testing.
World AIDS Day seems destined to be a time when we call attention to our failures in the face of the greatest public health crisis ever.
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