- The United Nations (UN) has just issued its latest AIDS
epidemic update. It is now 20 years since the immunodeficiency syndrome
that came to be known as AIDS was first reported. In that time the disease
has wrought death and debilitation across the planet. According to the
UN in that 20 years more than 60 million people have been infected with
the AIDS virus.
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- Worldwide it is the fourth largest killer, whilst in
sub- Saharan Africa it has become the foremost cause of death. The report
states that in the year 2001 there are 40 million people living with the
disease, five million people became infected and three million people died
as a result of AIDS.
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- The report picks out the course of the disease in various
regions of the world. Of the 40 million people with the disease, the
majority
are in sub-Saharan Africa, which has 28 million, whilst in South and
South-East
Asia there are over six million people with the disease.
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- The report says of those in sub-Saharan Africa,
"Without
adequate treatment and care, most of them [AIDS victims] will not survive
the next decade." In surveys of antenatal clinics in Botswana,
Swaziland
and parts of South Africa, there are HIV prevalence levels of over 30
percent.
Five West African countries - Burkina Faso, Cameroon, Cote díIvoire,
Nigeria and Togo - have adult prevalence levels in excess of five percent.
Apart from some isolated successes the overall picture is
devastating.
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- The report points out that in spite of the dangers of
the disease, many young African women are unaware of them. UNICEF has found
that 70 percent of adolescent girls in Somalia have not heard of AIDS,
corresponding figures for Guinea-Bissau and Sierra Leone are 40 percent.
The report says, "AIDS has become the biggest threat to the
continentís
redevelopment... essential services are being depleted at the same time
as state institutions and resources come under greater strain...the risks
of social unrest and even socio-political instability should not be
underestimated."
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- Eastern Europe and Central Asia, covering much of the
area that formed the Soviet Union and its East European satellite
countries,
has experienced the fastest rise in levels of HIV infection. The report
states that much of this increase is due to drug use among young people,
the sharing of needles being commonplace, and the increase in the number
of sex workers. It cites a survey, which shows condom use amongst sex
workers
(aged 17 to 23) in the Russian Federation is "erratic at best."
The report says, "Several factors are creating a fertile setting for
the epidemic: mass unemployment and economic insecurity beset much of the
region... public health services are steadily disintegrating."
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- South and South East Asia has over six million people
living with the disease. Its prevalence is highest among drug users and
sex workers. Past experience has shown that these groups can act as
reservoirs
for the disease which can easily spill out to the rest of the population.
The fear is that the prevalence of the disease in this region could
overtake
that of Africa.
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- What are described as the high-income countries are also
giving cause for concern. The report states that the up-to-now successful
use of anti-retroviral drugs to cut AIDS related deaths has led to
misplaced
perceptions that the disease can be cured. Consequently there has been
an increase in high-risk sexual behaviour. Within this region there are
variations in the levels of incidence related to racial discrimination
and health and income inequalities. It states, "In high-income
countries
there is evidence that HIV is moving into poorer and more deprived
communities."
In the USA African-Americans make up 47 percent of the AIDS cases yet
represent
only 12 percent of the population.
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- Life expectancy in the worst affected countries is
beginning
to drop sharply. In sub-Saharan Africa without the impact of AIDS life
expectancy would be 66. Instead it is 47. Twelve million children were
left orphaned by the disease up to the year 2000 and the figure is expected
to double in the next decade. The disease is also a big killer of children.
In the Bahamas it is the cause of 60 percent of deaths of under-fives,
whilst in Zimbabwe the figure is 70 percent.
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- In a section "Coping with Crisis" the report
says, "Unequal access to affordable treatment and adequate health
services is one of the main factors accounting for drastically different
survival rates among those living with HIV/AIDS in rich and poor countries
and communities... Also indispensable are functioning and affordable health
systems. Massive international support is needed to help countries meet
that challenge."
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- Even the production of condoms is below the level needed
to prevent the disease spreading. Currently world production of condoms
is about eight billion. Experts estimate that to have an impact on AIDS/HIV
the world needs to manufacture three- times this amount. UNAIDS estimate
only three percent of sexually active people in Africa use condoms.
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- Figures just released by the Nigerian government show
the prevalence of AIDS/HIV in Nigeria to be 5.8 percent of the adult
population.
Stella Iwuagwu, executive director of the Centre for the Right to Health,
warned, "Nigeria is the most populous country to have crossed the
five percent prevalence rate. That five percent prevalence rate is called
the threshold of disaster, because from that point the epidemic begins
to grow at an exponential rate."
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- Following an international AIDS summit hosted by Nigeria
last April, the government announced a programme making anti- retroviral
drugs available. There have now been three announcements, but no programme.
"They are still planning, they are still verifying, they are still
doing a lot of research, meanwhile people are dying," Iwuagwu
said.
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- A group of 60 poor countries known as the Africa Group
challenged the World Trade Organisationís Trade Related Intellectual
Property agreement (TRIP) at the WTO talks at Doha in November. The Africa
Group and its supporters wanted changes to the WTO rules to allow poor
countries to buy cheaper generic versions of the vital drugs.
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- They attacked the hypocrisy of the American government,
which has been able to force the pharmaceutical firm Bayer to reduce the
cost of Cipro, the anti-anthrax drug, in response to the mailing of
infected
envelopes, believed to have been carried out by right-wing US
extremists.
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- After extending the planned meeting by an extra day,
the WTO offered a limited concession over access to drugs for major
epidemics
such as HIV/AIDS. The final statement allowed WTO member countries to
manufacture
their own generic versions of drugs that are essential for combating public
health emergencies.
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- This confirms the existing arrangements the USA
authorities
used to force Bayer to sell them Cipro at a reduced rate. The new feature
is that AIDS/HIV is explicitly named as a disease that might be considered
a public health emergency. In practice, however, the new provision will
have little effect on the availability of drugs in most poor countries
because they do not have their own drug industries. The principal effect
of the declaration will to be to avoid a high-profile court case between
the drug companies and manufacturers of cheaper generic versions of drugs
in India and Brazil, which would have further damaged the already tarnished
image of the pharmaceutical industry.
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- Discussion of whether India and Brazil can legally export
generic drugs to other countries was postponed until next year. The only
country in sub-Saharan Africa with the ability to produce generic AIDS/HIV
drugs is South Africa. Even if the South African industry began producing
its own generics, other African countries could not at present import
them.
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- In an attempt to improve their public image some
pharmaceutical
companies have begun to offer cut-price drugs to African countries. But
even then many of them are still too expensive. In Kenya the government
passed a law in June this year with the intention of increasing
availability
of vital drugs, but even now the daily cost of anti retroviral drugs (ARVs)
in Kenya is between US$2.50 and US$5.00. The average income of a Kenyan
is a dollar a day. Dr Chris Ouma, of the NGO Action Aid working in Kenya,
says that since the law on access to cheaper drugs was passed 800,000 have
died of AIDS. Last year Merck began to offer its AIDS/HIV drugs Crixivan
and Stocrin to 100 countries for $600 and $500 a year per person. In the
US Crixivan costs about $6,000 a year per person and Stocrin about $4,700.
Charities and private insurers have taken up the Merck program in Kenya
and South Africa. Both have seen dramatic increases in the number of people
being treated. But the figures only emphasise the appalling low levels
of those receiving the appropriate drugs. In Kenya there has been a
fivefold
increase in the number of people receiving drug therapy, but that has only
taken the number to 1,000. In South Africa only 5,000 people have benefited
from the scheme, but this is 20 times the previous figure.
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- The Kenya Coalition for Access to Essential Medicines
(KCAEM) wants the life-saving treatment to be made available for all the
Kenyans that need it. Even at the reduced price, this would mean spending
one fifth of the entire Kenyan health ministryís budget and cutting
other programs, according to Health Minister Sam Ongeri.
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- In South Africa, the legal action begun in August this
year by the Treatment Action Campaign received a boost this week when the
judge hearing the case said that he thought the anti-HIV drug Nevirapine
should be freely available.
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- The drug helps reduce the spread of the infection from
mother to unborn child. A German pharmaceutical firm, Boehringer, has
offered
to provide it free of charge, but the South African government has refused
to accept the offer.
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- The use of Nevirapine would help reduce current numbers
of around 70,000 HIV positive children born each year. Even so, the near
five million adults and young people with HIV in South Africa would still
not receive the necessary drugs and treatment.
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- In April this year a Global Fund to fight AIDS,
Tuberculosis
and Malaria was launched with a great fanfare of publicity. Most experts
agree that to combat these major killer diseases, it would require an
annual
budget of $7-10 billion. Since its launch, $1.5 billion has been pledged
to the fund and most of that has still not materialised.
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- The US Congress originally agreed to allocate $1bn to
the fund, but this figure has now been cut to $190 million. Since the US
launched it so-called war against terror, the entire fund is under threat
and may be abandoned.
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- Six months after its launch the fund has no
administrative
structures and has disbursed no money. Mark Curtis, Head of Policy at the
charity Christian Aid, has attacked the fund, pointing out that it is
"not
delivering new money... money is being diverted from existing aid budgets.
Worse than that, as the pledged money remains unspent, it is actually
reducing
the money available."
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- A meeting of a consultative body of the fund in Baltimore
in October concluded that anti-AIDS drugs alone would not be enough without
an AIDS prevention program and public health services. Dr John G Bartlett,
chief of infectious diseases at the John Hopkins School of Medicine,
explained
that anti-viral drugs were needed, but "we canít just dump
therapy" on these countries. Trained workers are needed to ensure
patients take their medicine, for preventative measures, to stop mother
to child infection and for palliative care. "The UN has identified
AIDS as the greatest health crisis on Earth, and the epidemic of AIDS
threatens
the political, social and economic fabric of a substantial part of the
world," he said.
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- In the face of this disaster ministers from over 40
sub-Saharan
African countries met with top US government representatives at the end
of October. Instead of being offered debt relief or an increase in the
AIDS fund, they were subjected to lecturers from President Bush and his
top advisors.
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- The occasion was a forum meeting under the auspices of
the Africa Growth and Opportunity Act (AGOA) passed last year by the US
government. The measures of AGOA give duty free access to the US for
African
goods. However, to be eligible countries have to apply IMF adjustment
programmes
and allow US companies to penetrate home markets.
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- The charity Global AIDS Alliance has calculated that
to tackle AIDS in sub-Saharan Africa alone would cost US$15bn a year. This
is only a little more than the $14.5bn that these countries pay out each
year to service their debts. Far from offering help to the countries worst
hit by AIDS, Western banks, governments and the international financial
institutions are actually depriving sub-Saharan African countries of the
resources they need to combat the epidemic.
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- World leaders have written off the lives of millions
of people. Britainís International Development Secretary Clare Short
argues that the Global AIDS fund should only be used for preventative
measures
and not spent on drugs. She is prepared to deny the right to life to all
those already infected. Not only is this an offence against these
peopleís
democratic rights, it is an ineffective approach to combating the disease.
The French charity Medecins sans Frontieres argues that prevention must
be linked with treatment. Unless treatment is made available, there will
be no incentive for potential victims to come forward for testing.
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