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Is Africa Slipping Away?


The availability of antiretrovirals in Africa is changing the face of AIDS for the same reason the face of AIDS changed in gay America in the nineties:

Five years into what she jokingly calls her “marriage” to the medicine she takes twice each day, Moloi has a round face, swept-back hair and a plump body twice its previous size.

“Really, the results are fantastic,” Moloi said on a recent visit to Venter’s clinic. “I should have died a long time ago.”

South Africa’s medical system now reaches about twenty percent of those who need AIDS treatment, and with a great deal more effort, might someday reach half of those who need it. But adherence — people sticking to their medicine — is the best way to prevent mutations of the virus. And mutating around treatment, to create subtypes resistant to medication, is the virus’ best hope. And humanity’s worst nightmare.

The World Health Organization reported in April that 1.3 million Africans were taking antiretrovirals, an increase from 100,000 just three years earlier. But most programs lack the ability to track how many of their patients continue taking the medicine.

Boston University epidemiologist Christopher J. Gill studied African treatment programs that did monitor the outcomes of all of their patients, a group that encompassed 66,753 people in 13 countries. Gill found that 40 percent of the patients could not be accounted for after two years, meaning that they had stopped taking their medicine, transferred to another program or died.

The other component to any AIDS fight — prevention — is also not taking root in Africa. Partly because it’s not funded as well as treatment and partly because there are cultural barriers to talking about prevention. But it’s failing:

For every South African who started taking antiretroviral drugs last year, five others contracted HIV, the same ratio as on the continent as a whole, U.N. reports say. A South African turning 15 today has a nearly 50 percent chance of contracting the virus in his or her lifetime, research shows.

Worse yet, people who are returning to life because of antiretrovirals aren’t being given the talk and the tools to allow them to live responsibly with HIV/AIDS:

National prevention programs, which have emphasized condom use and HIV testing but rarely featured frank discussions of the dangers of multiple sex partners, have done no better, Venter said. Health officials have also shown little enthusiasm for expanding access to circumcision, despite research showing that it can dramatically slow the pace of new infections.

“South Africa has had huge money poured into it for prevention and done diddly squat,” he said.

The doctors who treat this disease know prevention is a part of HIV/AIDS treatment. There’s a critical role for prevention. These doctors don’t see the results they’ll require if treatment they provide is to make a difference:

“On the public health level, it’s not going to make much of a difference,” he said. “I don’t think we’re going to treat ourselves out of this epidemic. . . . No way.”

UPDATE: House Democrats yesterday made a start on the prevention front, by undoing the notorious Mexico City policy:

House Democrats narrowly passed a measure yesterday to provide contraceptives to overseas organizations that had been banned from receiving foreign aid because they provided or promoted abortion.

The amendment to an important antiabortion measure in the House foreign aid spending bill was a rebuke to President Bush, who has strictly opposed providing any assistance to groups that promote abortion. The Reagan-era measure, known as the Mexico City policy, was fiercely protected by Bush, who has issued two veto threats over the foreign aid bill should Democrats attempt to alter any of the antiabortion measures it contains.

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