| London
When activists gather in Toronto for the 2006 Aids summit to demand yet
more money for the UN goal of treating 10 million sufferers, no-one will
be admitting this figure is an educated guess, at best. This simple but
avoided truth has massive implications for the way we fight the
disease.
The figures before the XVI International Aids Conference
this week are based on estimates and extrapolations, not on blood tests.
In rich countries, you cannot be classified as carrying HIV without a
blood test. In poorer countries, with the majority of HIV infections, a
patient can be classified as HIV positive simply with a combination of
visible symptoms or infections, such as tuberculosis or diarrhoea. The
problem is, these symptoms are already widely prevalent in any poor
country simply as a result of bad water and poor nourishment.
The
Toronto summits slogan is Time to Deliver. How can we deliver if we
have inaccurate data about who is suffering and where? Several things
could significantly reduce HIV/Aids in developing countries and especially
those in Africa. The truth is that not only HIV/Aids, but all the diseases
associated with it, such as tuberculosis and recurrent diarrhoea, are
mainly caused by poverty.
These diseases can only be cured by economic
growth.
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Health Minister Dr
Mallinga |
Admittedly, this is a long-term strategy. In the short-term, we can
finance treatment, health education and, perhaps, the development of an
HIV vaccine. But these are not without risk. Currently, there is a huge
policy emphasis on supplying anti-retroviral treatment (ARVs) to HIV/Aids
sufferers in least-developed countries.
This is utterly
unrealistic when one considers the majority of the approximate 40 million
people living with HIV live mainly in countries where health
infrastructure is entirely inadequate.
There is not only the cost
of the drugs to consider but also the considerable task of monitoring and
administrating complex treatment schedules. The 2005 estimates given by
UNAIDS indicate global resource requirements amount to $15b in 2006, $18b
in 2007 and $22b in 2008 for prevention, treatment, care, support for
orphans and vulnerable children, as well as programme and human resource
costs.
This translates into about $375 per annum per person living
with HIV. This figure seems a gross underestimate when compared with the
same figure of about $14,000 per annum required in the USA. The likelihood
is that $22b wont even begin to pay the bills. Add into the mix the high
levels of useless counterfeit medicines that are floating around
developing countries and you have a recipe for a clinical
disaster.
At any rate, these figures are based on guesswork. The
epidemiology used to identify and quantify Aids cases in developing
countries is largely unreliable, flawed and is often subject to undue
influence from pressure groups. These statistics are either derived from
extrapolations of limited samples or from estimates made using an ad hoc
definition of HIV/Aids, which was devised in 1985 by the WHO at Bangui in
Central Africa for use in countries lacking facilities for
diagnosis.
The 1985 definition, which is still in use, does not
require an HIV test but allows Aids to be diagnosed by symptoms: weight
loss of more than 10% or fever and cough for more than one month. However,
these symptoms are not exclusive to Aids, they are symptoms of almost all
the diseases of poverty.
There is, of course, every reason for
countries to boost their figures in order to attract international health
aid. Despite these uncertainties, not UN Aids nor WHO nor any other
authority responsible for health aid has expressed doubt about their Aids
figures. In all the developed countries of North America, Europe and Asia,
where clinical diagnosis confirms HIV infection, the origins and spread of
Aids are consistently linked to high risk sexual and drug-related
behaviours. But Sub-Saharan Africa and other areas suffer from prevalence
in the general population and there is no clinical evidence to determine
why, except for the one definite major cause of any disease-
poverty.
The immediate lesson is that abstinence and safe sex work
but that it is very hard to educate whole populations; at the same time,
throwing money at partial solutions is useless. The medium-term lesson is
that prosperity is the best preventative not just for Aids but for all
diseases: better nourished people in clean environments simply resist
diseases better.
Such prosperity is an economic issue, not one for
health bureaucrats at Toronto playing with other peoples money. Money for
drugs can only make a dent in the pandemic. With economic freedoms such as
open markets, property rights and enforceable contracts, the poor could
start saving themselves.
Dr Barrie Craven is Reader in Public
Accountability at University of Northumbria
Gordon Stewart is
Emeritus Professor of Public Health at University of Glasgow
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