HIV Epidemic

Photo by Nigel Sanders-Self

The HIV epidemic in Africa poses the largest social and scientific challenge to public health ever known.

 Human Immunodeficiency Virus infection and its associated complications are rapidly eclipsing all other causes of death among men women and children in Africa as the epidemic continues to increase in intensity. In Southern Africa, more than 30% of women attending antenatal clinics are HIV seropositive. Mother to child transmission of HIV infection has led to a more than 4-fold increase in infant mortality and at least 25% of infants born to seropositive women acquire HIV infection; with even higher infection rates with prolonged breast-feeding. Increasing rates of infection, morbidity and mortality among men and women contribute further loss of life, productive capacity and health as parents die, children are orphaned and the extended family network is placed under increasing strain. Many of the current military conflicts, political and economic instabilities in Africa, and most importantly the suffering of millions of individuals are the result of this terrible epidemic.

In response, private sector and government programs in Africa have focused on prevention research through condom distribution, information and education. Voluntary counseling and testing programs, and continuing programs aimed at the long-term issues of vaccine and microbicide development are all intended to save future generations of Africans. The bulk of funding is currently directed towards "care", efforts to ease the suffering of orphans, the economic hardships accompanying a wave of death, and the provision of home and hospital based terminal hospice care.

Photo by Nigel Sanders-Self

Morally, and historically, the medical, public health and scientific community are completely failing to confront a critical challenge to our humanity, technical, scientific and economic capacity. The current failure to implement solutions to pressing problems means that we are engaging in a terrible hypocrisy. The United United States and Europe have "solved" the problem of AIDS, or at least reached a compromise in which the production, distribution and access to antiretroviral drugs, as combination therapies, has resulted in a 90% decrease in mortality rates due to AIDS. This has been largely subsidized by government, which has worked assiduously with the Pharmaceutical Industry to create an extraordinary miracle, changing a universally fatal condition into a chronic disease over the course of 12 years. Antiretroviral drugs increase CD4 cell numbers (reversing the immunodeficiency of AIDS), reduce virus load and prolong survival in HIV infection. This far we have seen only 5-6 years of real progress, but in the U.S. and Europe it has become clear that even costs of $10-20,000 per person per year are "cost-saving" in that the medical care systems are no longer burdened with the anguish and expense of the deaths of tens of thousands young, productive members of society. We have led the way towards equity in health care, within our borders, by providing access to life saving drugs to several hundred thousand men, women and children, regardless of their ability to pay or their perceived value to society.

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