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Subject: [TriumphOfContent] Recession and compassion fatigue starve Africa
of cash to cope with Aids epidemic


  




  


Recession and compassion fatigue starve Africa of cash to cope with Aids
epidemic



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Published Date: 23 May 2010
By Donald McNeil
IN THE grounds of Uganda's biggest Aids clinic, Dinavance Kamukama sits
under a tree and weeps.

Her disease is probably quite advanced: her kidneys are failing and she is
so weak she can barely walk. Leaving her young daughter with the family, she
took a four-hour bus journey to the hospital where her cousin, Allen
Bamurekye, born infected, bot 
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h works and receives the drugs that keep her alive. 

But there are no drugs for Kamukama. As is happening in other clinics in
Kampala, all new patients go on a waiting list. A slot opens when a patient
dies. 

"So many people are being supported by America," Kamukama, 28, said. "Can
they not help me as well?" 

The answer increasingly is no. Uganda is the first and most obvious example
of how the war on global Aids is falling apart. 

The past decade has been what some doctors call a "golden window" for
treatment. Drugs that once cost £8,000 a year fell to less than £70, and the
world was willing to pay. 

In Uganda, where fewer than 10,000 were on drugs a decade ago, nearly
200,000 now are, largely as a result of American generosity. But the golden
window is closing. 

Uganda is the first country where major clinics routinely turn people away,
but it will not be the last. In neighbouring Kenya, grants to keep 200,000
on drugs will expire soon. An American-run programme in Mozambique has been
told to stop opening clinics. There have been drug shortages in Nigeria and
Swaziland. Tanzania and Botswana are trimming treatment slots, according to
a report by the medical charity Doctors Without Borders. 

The collapse was set off by the global recession's effect on donors, and by
a growing sense that more lives would be saved by fighting other, cheaper
diseases despite the number of people infected by Aids growing by a million
a year.

Other forces made failure almost inevitable. Science has produced no magic
bullet – no cure, no vaccine, no widely accepted female condom. Every
proposal for controlling the epidemic with current tools – like giving a
daily prophylactic pill to everyone contemplating sex or testing billions of
people and treating all the estimated 33 million who would test positive –
is wildly impractical. 

And, most devastating of all, old-fashioned prevention has flopped. Too few
people, particularly in Africa, are using the "ABC" approach pioneered here
in Uganda: abstain, be faithful, use condoms. 

For every 100 people put on treatment, 250 are newly infected, according to
the United Nations' Aids-fighting agency, Unaids. 

That makes prospects for the future grim. Worldwide, even though two million
people with the disease die each year, the total keeps growing because
nearly three million adults and children become infected. 

Even now, the fight is falling short. Of the 33 million people infected, 14
million are immuno-compromised enough to need drugs now, under the latest
World Health Organisation guidelines.

Instead, despite a superhuman effort by donors, fewer than four million are
on treatment. Just to meet the minimal WHO guidelines, donations would have
to treble instead of going flat. 

Uganda is a microcosm of that: 500,000 need treatment, 200,000 are getting
it, but each year, an additional 110,000 are infected. 

"You cannot mop the floor when the tap is still running on it," said Dr
David Kihumuro Apuuli, director-general of the Uganda Aids Commission. 

As he tours world capitals seeking donations, Dr Michel Kazatchkine,
executive director of the Global Fund to Fight Aids, Tuberculosis and
Malaria, said he had become "hugely frustrated". 

"The consistent answer I hear is: 'We love you, we hear you, we acknowledge
the fund's good results, but our budget is tight, our budget is cut, it's
the economic crisis.' " 

Donors give about £7 billion a year, while controlling the epidemic would
cost £19bn a year, according to estimates.

AIDS2031, a panel looking ahead to the epidemic's 50th anniversary, issued a
pessimistic report in November that concluded: "Without a change in
approach, a major epidemic will still be with us in 2031." Because of
population growth, it said, there may still be two million new infections a
year even then. 

Under its new Global Health Initiative, the US administration of Barack
Obama has announced plans to shift its focus to mother-and-child health. The
Aids budget was increased by only 2 per cent. 

The British government and the Bill and Melinda Gates Foundation also said
they would focus support on mother-child health. 

"The political winds have changed," said Sharonann Lynch, chief author of
the Doctors Without Borders report. "And I don't believe for a minute it's
just the economic downturn. I think world leaders feel the heat is off and
they're fatigued." 
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