News Slant	News Slant Archive

The AIDS crisis is over, opine prominent gay observers. Thanks to last decade's activism, there is in place a massive research, education, and service infrastructure. Deaths continue-- 39,000 in the US last year-- but protease inhibitors have helped people with AIDS spring back to health from sickbeds and sent the blood virus counts of some down to zero. For the 90 percent of the world's HIV-infected people living outside rich countries, however, the AIDS crisis continues. The new drugs, and most of the old ones, are out of reach. "It is shameful to let AIDS patients in poor countries die without benefiting from the new treatments available to those living in developed countries," Federico Mayor, the head of UNESCO, said on December 1st, World AIDS Day. A tiny new United Nations effort to bring AIDS meds to the world's poor may change that a little.

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The UN's pilot program, announced in November, will operate in Chile, the Ivory Coast, Uganda, and Vietnam. Western pharmaceutical companies will sell their medicines to these governments at a discount and do the lab work and monitoring for recipients. National boards comprised of public health officials, doctors, and people with AIDS will hash out the touchy details of eligibility for the usually unavailable treatments. A non-profit corporation in each country will distribute the drugs, which will include antivirals, along with antibiotics for opportunistic infections and the sexually transmitted diseases that increase risk of HIV transmission.

The task is not simply to channel cheap drugs to the poor, but to figure out how they can best be used in the context of poor-country health systems where money and resources are scarce. "In order to evaluate and perfect the approaches we are trying, we must begin with small-scale pilot programs involving tough decisions to determine the limits of participation," said Dr. Peter Piot, director of UNAIDS. "But the alternative is to do nothing."

Demand won't be lacking. The number of people infected with HIV in the developing world, and the rate of new infections, is far higher than previously thought, according to a report issued in December from the World Health Organization. Worldwide, AIDS deaths in 1997-- 2.3 million-- were 50 percent higher than in 1996. Some 16,000 people a day were newly infected in 1997. Worldwide, one in out of every 100 persons ages 15 to 49 has HIV. In sub-Saharan Africa, the figure is 7.4 out of 100. By 2000, WHO estimates there will be 40 million HIV-infected persons, up a third from today.

In worst-hit countries, such as Zimbabwe, perhaps as many as 20 percent of adults are HIV positive.

Given that it was modern medicine-- particularly dirty needles used for vaccinations-- that helped spread HIV initially in many developing countires, bringing some of the fruits of rich-nation medicine to the poor seems especially appropriate. But the transfer of new drugs is mostly window dressing. Expensive treatments will not mean much in countries where annual spending per head on health care often is less than an American family spends for a night at the movies. Already low, social spending in poor countries is being cut under pressure from the US and other Western creditors, who value debt repayment more than poor people's lives.

Extending lives of people with AIDS in poor countries has more to do with improving sanitation and basic health care. Routine and chronic infections in the developing world are the prime killers of immune-compromised AIDS patients, and cutting-edge HIV drugs wouldn't help.

To deal with the underlying cause of HIV's devastation among the world's poor, some critics suggest, would mean changing social and economic fundamentals. It would require addressing the poverty that forces men to leave their families in villages to work in cities, and the inequality denies women control over their reproductive lives. "In the long run," contend health activists David Werner and David Sanders, "social justice will do more to slow the spread of HIV than current attempts to promote safe sex." On present form, that means the AIDS crisis is here to stay.