Recently the Seattle Post-Intelligencer printed a thoughtful and timely
editorial on the AIDS crisis in
Africa.The devastation that the AIDS infection has brought to that
continent also has been the subject of an ambitious series of stories in
the Boston Globe, a cover story in Newsweek and a meeting of the United
Nations Security Council.
We in the United States may
have a false sense of comfort from some recent successes in the battle
against AIDS. Drug treatments such as the AIDS "cocktail" can allow people
who are HIV positive or who have developed AIDS to co-exist with the
disease. Still, the battle here is far from over, especially among
minority populations.
But in Africa it is unrelenting. There are 11 million AIDS orphans in
sub-Saharan Africa, a number that is expected to reach 40 million. The
result of this reawakening of concern has prompted calls for a major
international effort to find a cure for the disease. I am glad to see
American political leaders put this issue on the front burner. But before
we spend billions on a "Manhattan Project" to combat AIDS, let me tell you
about what I have learned in my own battle to do something about the AIDS
epidemic, as well as to suggest some cost-effective approaches that could
have an impact right away and not in the distant future.
When we first learned about AIDS more than 20 years ago, many people
said we didn't need to do anything about it because "we" weren't going to
get it. It was a disease of gay men, or drug users who shared needles. Not
us.
But the American sentiment about a need to find a treatment for AIDS
changed as the victims became people close to us.
Once again, the news about AIDS isn't about us. It is only through
these dramatic news reports that we learn how Africa, the continent where
AIDS first was discovered, is being devastated by the disease.
I first became aware of the AIDS epidemic while serving in the state
Legislature in the '80s. As chairman of the Senate Ways and Means
Committee, I was able to put in the budget the first $200,000 for AIDS
education. That was in 1986. The next year, we doubled it. In a literate,
wealthy society like ours, education -- encouraging safe-sex techniques,
for example -- would make a difference in the spread of the infection.
But it was about that time that I left politics -- I thought -- to
become a traveling physician and psychiatrist for the U.S. State
Department in Africa. Although my assignment was to treat American
government employees, you couldn't walk into a hospital in Kinshasa or
Lusaka without seeing the rows of patients lying on the floor in ward
after ward. Seeing it made the epidemic real for me in a way I hadn't
experienced.
When I returned to the United States and was elected to Congress in
1988, one of my goals was to alert our government to the international
AIDS crisis. Shortly after I was elected, a friend of mine, the regional
medical officer in Johannesburg, South Africa, asked me to come and view
the situation there.
Workers from Zimbabwe and Malawi would be brought to South Africa to
work in the mines. The mine owners would spend time and money training
them to operate heavy equipment, and then a few months later they'd be
dead of AIDS, having brought the disease with them. You could see it
spread as it moved with the workers down the truck routes. My friend said:
"The government is committing genocide over here."
Unfortunately, I could not do much about it in Congress. At the time,
South Africa still had an all-white apartheid government, and the U.S.
Congress was too invested in sanctions against the government to allow
even medical assistance for South Africa.
I did continue investigating the disease, however. I traveled to India,
Southeast Asia and South America to see the impact of HIV infection. I
formed the International AIDS Task Force to raise awareness among members
of Congress. In 1992, I got foundations to donate $250,000 so I could put
on a conference in Washington, D.C., with health experts and political
leaders from all over the world.
Many of the predictions made at that forum have turned out to be true:
the growth of AIDS among women, for example, and the economic and social
impact on African countries as more and more members of the adult
population were wiped out.
Now 33 million people are infected with the HIV virus, three times what
it was when our conference was held. About two-thirds of the cases are in
Africa alone, including 90 percent of the new HIV infections. South Africa
now has the highest rate of new HIV infections in the world. About 12
million Africans have died from the disease -- 10 times as many as have
died from wars in the same period.
Recently, Vice President Al Gore said at a meeting of the U.N. Security
Council that Congress will be asked to allocate $100 million for AIDS
treatment and prevention programs, and $50 million for research on a
vaccine. President Clinton made the same promise in his State of the Union
address.
I applaud the high profile this issue is being given. But all of my
training and involvement with the epidemic suggest that while raising the
profile is a good symbolic statement, until we begin to support
community-based responses to HIV and AIDS, the death march will continue.
My suggestions won't lead immediately to a cure, but they could provide
significant relief:
Education and prevention have always been the most-effective weapons
at halting the spread of AIDS. Specifically, that means getting people to
use condoms.
One of the recommendations that came out of my AIDS conference was to
make condoms cheap and readily available. We need to support a program of
mass distribution, through churches and other community organizations in
Africa. But condom use is not an easy sell. Social mores prevent even the
discussion of sex in many African cultures. Many African men refuse to
wear condoms. A successful program will have to include use of condoms
made for women.
One thing we can do is to help set up manufacturing plants in Africa so
condoms can be produced there and distributed generously and cheaply.
We should provide medicine for nursing mothers. Usually, babies born
to women with AIDS do not have the infection at birth. They develop it
while nursing. For about $4 each, we can provide medicine that will keep
the babies from developing the infection.
Money provided for prevention and education should go to the lowest
levels of community organization -- towns and villages, rather than
national governments.
More than $1 billion has been spent on AIDS in Africa, but it hasn't
all been spent effectively. At one point, we found that of every dollar
for African AIDS programs, 53 cents stayed in the Washington, D.C., area.
This battle can't be fought in the Beltway. It has to be on the local
level in Africa. One practical and inexpensive step would be to distribute
wind-up radios in the rural areas. The radios, which don't require
batteries or an electrical outlet, can be used for information programs
from the Voice of America and other sources as part of a continuing effort
to educate people on AIDS prevention.
I am not yet ready to join those who would put the responsibility for
solving this problem at the doorstep of pharmaceutical manufacturers and
say that we need to waive patent rights to allow manufacture of AIDS
medicines cheaply in Africa. It's an open question whether it would do any
good to make the $40,000-a-year AIDS cocktail available to every African,
even if we could afford it immediately.
Of course, the perfect solution would be to develop vaccine, but that
is an expensive and problematic operation. Any new medicine involves
testing on human subjects. In the old days, we would just pick out a
foreign population and try the initial tests on them, with some patients
getting active antibodies and others just a placebo. But native
populations are no longer willing to be the world's guinea pigs.
In addition, drug companies are unwilling to accept the risk of testing
vaccine that may be fatal to some subjects. If you were making a vaccine
to prevent the mumps, you'd test your vaccine and see who developed mumps.
Some people would get it, but then they would get over it. It doesn't work
that way with AIDS. Whoever gets it dies. The traditional approach won't
work with this disease.
Instead, we need to work through programs such as the International
AIDS Vaccine Initiative (IAVI,) which is establishing links with African
nations to allow drug testing. In exchange, African countries will receive
quantities of the vaccine at prices they can afford. Key financing for
IAVI has come from the Gates Foundation, formed by Microsoft founder Bill
Gates.
Finally, we need to see AIDS in Africa as more than just a disease but
a long-term social issue.
About 10 years ago, I visited with Zambian President Kenneth Kuanda. He
told me, "I don't know what I am going to do when I have 500,000 orphans
on the streets of Lusaka." Now they are there.
What will happen to all those kids? Who will house and educate them?
Will they be able to get jobs and be productive? We must bring Africa into
the world economically by fostering trade and investment. Only by allowing
Africa to become economically productive, with its own public-health
infrastructure, can there be any long-term approach to the AIDS epidemic.
There is no simple solution. AIDS has to be fought house to house,
village to village. It must be fought at the most basic level of society
because we are trying to change the most personal of all human behaviors,
sexual behavior. It cannot be changed by edicts from the capital, only by
convincing men and women they must be aware of the disease and act
appropriately to avoid getting it.
Seattle Democrat Jim McDermott represents the 7th Congressional
District.
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