of neglect, the UN is finally focused on Aids
The Nation (Thailand) August 24, 2006
After three years of throwing
money at Aids treatment programmes while ignoring
the vital task of prevention, the head of UNAids
announced last week that prevention is the key to
defeating the Aids pandemic.
This switch of
strategy by Peter Piot at the bi-annual Aids
conference in Toronto is welcome but it raises
serious questions about the competence of UN high
Under the UN's
guidance, the last few years have seen new
infections soaring and money going into grandiose
but unrealistic treatment programmes that have
delivered terrible value for money and endangered
patients. And the legacy of the UN's treatment
programmes will be a form of economic welfare
dependency for the worst-afflicted countries that
will entrench poverty without reducing Aids.
This all started at
the 2000 International Aids conference in South
Africa. Around this time, advances in medical
science were making Aids in the West a manageable
(but not curable) condition, as opposed to the
automatic death sentence it had been a few years
previously. Health activists thought - not
unreasonably - that if American Aids patients
could get the miracle drugs, why shouldn't people
in poor countries?
In 2003, the UN
transformed the activists' demands into policy by
creating the "3 by 5" programme, a plan to put
three million Aids sufferers in lower-income
countries on anti-retroviral (ARV) treatment by
well-intentioned goal ignored some home truths,
apart from the fact that ARVs are only
palliatives, not cures. The most obvious is that
countries with the worst Aids problems also have
the fewest doctors, nurses and clinics.
In Nigeria, for
example, there are only 28 doctors for every
100,000 people. How did the UN expect to massively
"scale-up" treatment if the people were not there
to administer the drugs?
The answer is that
it couldn't: at the end of 2005 only 1.3 million
people were receiving treatment.
Of course, it is to
be celebrated that these people have been given
the chance to live longer but these wild promises
gave false hopes.
While the UN earned
political kudos among activists for being seen to
do something about treatment, it neglected the one
and only way to reverse the pandemic: prevention.
This has been a
betrayal of the 4.9 million people who were
infected in 2005 alone.
These people all
now need to be added to the tens of millions of
patients already needing expensive and difficult
treatment: the UN has created a vicious and
growing circle of suffering and death.
require clinical supervision and adherence to a
without appropriate medical infrastructure, there
is a risk that patients will miss doses, or even
share drugs among their families - an invitation
for the virus to mutate and develop resistance to
before 1996 showed a drug resistance to existing
HIV strains of about 5-per cent, rising to at
least 15 per cent between 1999 and 2003. This all
implies significant extra costs, as drug-resistant
patients have to be moved onto expensive second-
and third-line therapies.
mismanagement of funds, inefficiency, waste,
overpriced technical assistance and corruption
within recipient governments has meant that the
cost of treating a developing-country patient for
two years ballooned to US$12,538 (Bt471,669) by
the end of 2005 - nearly 10 times the $1,633 that
was initially estimated by UNAids.
Based on this past
performance, the goal of sustaining many years of
ARV treatment for 10 million people will be
astronomical. At the very least, it will leave
precious little aid available for the myriad other
diseases that affect Africa.
failure of the "3 by 5" programme taught the UN it
needs to invest in infrastructure if it is to meet
its 2010 treatment targets, so it now plans to
spend $750 million on building clinics between now
The UN has not
explained, however, who is going to pay for the
maintenance of the clinics or salaries. This
requires a large amount of hard foreign currency,
something that is in desperately short supply in
Either the new
hospitals will slowly rot or OECD donors (mainly
the US) will have to finance them in perpetuity.
But the influx of the billions of dollars of
foreign currency necessary to maintain them could
wreak all kinds of macroeconomic damage, such as
the rapid appreciation of local exchange rates,
inflation and fiscal volatility. These hurt the
poor the most.
In effect, the UN's
failure to prioritise prevention earlier and get a
grip on the pandemic is now forcing it to create
OECD-financed welfare states in sub-Saharan Africa
that are unsustainable for donors and bad for
Good intentions are
no substitute for accountability when things go
wrong. UNAids needs more than just a new slogan:
it needs leaders capable of spreading the loud and
practical message that treatment cannot cure Aids
and that prevention is the only way to save
millions more from pain, poverty and death.
Philip Stevens is
director of the Campaign for Fighting Diseases,
London, an international development think-tank.
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