By Xiong Lei
One could not ignore the striking disparities in global
anti-AIDS efforts when 24,000 top-notch medical researchers,
patients, activists and government officials gathered at the
week-long 16th International AIDS Conference in Toronto last
week.
There is the disparity in survival rates of people living with
HIV/AIDS in rich and poor countries, for instance.
The UNAIDS data indicate that "in low- and middle-income
countries, mortality rates for 15-49-year-olds living with HIV are
now up to 20 times greater than death rates for people living with
HIV in industrialized countries." In low- and middle-income
countries, HIV-infected individuals in their forties experience
annual death rates of 90-200 per 1000.
"We have high-level commitments; we have financial resources;
and we also have antiretrovirals," said Frika Iskandar, a
25-year-old Indonesian who has been HIV positive since age 18. "But
we can't deliver to those who need it the most people who are far
away from the capital or major cities."
Here, human rights seem to pale in front of intellectual
property rights UNAIDS and many developing countries have found it
hard to get the giant pharmaceuticals that manufacture
antiretrovirals to make their drugs affordable to people in low-
and middle-income countries who need them.
Even Sofia Gruskin, associate professor of health and human
rights and director of the program on international health and
human rights at the United States' Harvard School of Public Health,
said human rights "is no solution" to the issue.
There have been international programs to address the dilemma
HIV-positive people have faced in poor countries, with increased
funding to facilitate their access to appropriate treatment. Still,
four-fifths of the over 6 million people living with HIV/AIDS who
are in need of medication in these countries cannot get it,
according to UNAIDS.
So Iskandar, now advisor of a regional network of people living
with HIV/AIDS, asked the international gathering in Toronto "why
most of the money does not reach communities."
The Indonesian, who happened to be born in the year when AIDS
was discovered, is among the lucky few who only takes three pills a
day, a simpler packaging of antiretrovirals. As Peter Piot,
executive director of UNAIDS, frankly noted, "Most active pioneers
of the fight against AIDS should benefit first from treatment."
While antiretroviral therapy is not for everybody, the majority of
HIV-positive people in developing countries who have access to
medication, if any, have to put up with the conventional regimen of
at least nine pills a day.
Aside from disparities in the survival rate and accessibility to
treatment, the disparity in distribution of resources is also
stunning. Billions of dollars have been thrown into the research
and development of antiretrovials, without any resulting cure to
end the epidemic. Then came projects on prevention methods, such as
male and female condoms, microbicides and vaccines, with no certain
effect for the latter two.
In all these research efforts, said Pam Barnes, president and
chief executive officer of the Elizabeth Glaser Pediatric AIDS
Foundation, "children have been grossly neglected in the world's
response to AIDS," although everyday 1,800 children become newly
infected with HIV and half a million kids will die this year
alone.
"The special needs of children when it comes to care and
treatment are still being ignored," she said. "If we continue to
treat children as small adults, we can seriously jeopardize their
health." The youngest children cannot swallow pills. But "many
HIV/AIDS medicines still have not been tested for children."
Also neglected is the simple truth poor nutrition compromises
the human immune system and causes vulnerability with HIV. Yet
resources available to food security and nutrition are scarce
compared to those allocated to AIDS medication and prevention,
observed Dr. Gabriel Rugalema, senior officer of HIV/AIDS and Food
Security at the Food and Agriculture Organization of the United
Nations.
"Hungry people cannot eat medication," said Rugalema.
Complaining that his program has a very small budget, he said,
"It's difficult to argue these cases, as AIDS is still seen as a
medical problem rather than a nutrition problem."
But it is obvious that when infected with HIV, people with good
nutrition can survive longer than those with malnutrition.
Also apparent is the disparity in research between developed and
developing countries, as the former have dominated the research in
medication and prevention technologies. Although more medical
scientists from developing countries have been involved in
international programs of AIDS research in recent years, they are
far from getting an equal footing with their counterparts from
developed countries.
Even if they are heavily engaged in critical clinical trials,
developing countries "are very weak" in sharing benefits such as
patent rights, said Dr Pontiano Kaleebu, assistant director of the
Viral Institute of Uganda.
AIDS has a singular amount of global attention and resources. No
other disease has ever prompted the United Nations to set up a
special office and ignited 16 international conferences to deal
with it.
This is because AIDS was not known to exist 25 years ago and has
killed so many people so quickly, said Helence Gayle, co-chair of
the Toronto International AIDS Conference and president of
International AIDS Society that initiated the biannual event in
1985.
Gayle acknowledged that more and more people have realized that
one cannot solve the problem by dealing with AIDS alone. "That's
why the conference has become more inclusive by incorporating
topics of poverty elimination, tuberculosis, malaria, etc into its
programs," she said.
That justifies that one cannot ignore these disparities in the
global fight against AIDS. Otherwise, I doubt if those wonderful
programs can get anywhere.
The author is a council member of China Society for Human
Rights Studies.
(China Daily August 24, 2006)
