June 1, 2001
The global AIDS crisis is finally making headlines in the United States. Public outcry over alarming death rates from the disease-more than 8000 people per day-has at last begun to catalyze political action and drive down drug prices.
But challenges to adequate care and treatment for people living with HIV in the developing world remain daunting. Lack of financial and political commitment from both wealthy and poor nations, inadequate health delivery systems in some areas, and even debate over the "cost effectiveness" of providing treatment versus investing in prevention and vaccine research-are just a few of the obstacles to providing the 34 million people currently living with HIV/AIDS in the developing world access to the medical care they need.
In this issue of Alert, several Doctors Without Borders/Médecins Sans Frontières (MSF) field projects present their insights on treating HIV/AIDS in Africa, Latin America, Asia, and Eastern Europe.
MSF's experience with the HIV/AIDS crisis began in the late 1980s. Initially, the organization devoted its resources to preventing the spread of the disease. By 1997, MSF was running 30 HIV/AIDS projects, still aimed primarily at prevention. However, by this time, powerful but expensive new drug "cocktails" of antiretroviral therapies were dramatically extending and improving the lives of people with AIDS, but only in wealthy countries.
Meanwhile, infection rates soared in the developing world. Clearly, "prevention only" measures were not stemming the spread of the disease. In addition, for MSF doctors, it was unethical and unacceptable to send their patients home to die simply because the new medicines were unaffordable. With this in mind, the question was no longer whether to begin HIV/AIDS treatment in poor countries, but how to do it.
Although limited, MSF's experience has shown that offering treatment is now feasible, even in resource-limited settings. My colleagues working in MSF's pilot treatment programs in Cameroon, South Africa, and the Ukraine have found that offering the possibility of treatment is a powerful incentive for individuals to get tested and learn their HIV status, a crucial first step for effective prevention activities. The hope of treatment helps break the vicious cycle of denial of the disease and of social stigma associated with HIV. Offering treatment also motivates poor countries to mobilize resources and strengthen their health-care infrastructures.
There is still an urgent need for operational research to determine how to best provide and monitor antiretroviral treatment in resource-poor settings. A reliable supply of antiretroviral medicines with guaranteed long-term affordability is needed to ensure patient compliance, successful treatment, and prevention of drug resistance. Substantial investment is also needed in health-care delivery systems-personnel, diagnostics, supplies, equipment, and facilities-to sustain care for the longterm.
MSF is aware that our organization alone will not be able to provide treatment to all of those in need in the countries where we work. That is why we have joined activists from South Africa to Thailand and the United States in seeking global access to HIV/AIDS drugs and other essential medicines.
A serious global effort to end the HIV/AIDS pandemic will require massive mobilization of financial resources from wealthy nations as well as real political commitment on the part of poor countries to implement comprehensive programs that provide a continuum of care, including fully integrated prevention and treatment activities. With our medical programs and advocacy efforts, MSF is pressing for this to become a reality. 8000 people dying per day from HIV/AIDS is 8000 too many.
© 2013 Doctors Without Borders/Médecins Sans Frontières (MSF)