Category Archives: AIDS

Uganda, HIV — The Success that Wasn’t

Not too long ago we were touting the wonders of abstinence education and the HIV control program in Uganda. More here and here. You may recall the emphasis of the Ugandan anti HIV education program, encouraged by the Bush administrations, away from use of condoms to abstinence. They claimed, prematurely it seems, to have the HIV epidemic under control.

However:

In the 1980s, Uganda earned renown for pushing its infection rate to 6 percent from 18 percent. Many here still remember the pounding drums on the radio and the slogans “Practice ABC” and “zero grazing” — no extramarital sex.

But infection rates are creeping back up. Casual sex is on the rise, epidemiological surveys say.

Condom use, never very high, has dropped. Even among people who know they are infected, only 30 percent consistently use condoms.

link: In Africa, Cultural Obstacles to Safe Sex Drive HIV Infections – NYTimes.com

Abstinence education if it isn’t accepted by the population didn’t work. And while the epidemic is reasserting itself the international community is suffering from HIV assistance fatigue.

Uganda is the first country where major clinics routinely turn people away, but it will not be the last. In Kenya next door, grants to keep 200,000 on drugs will expire soon. An American-run program in Mozambique has been told to stop opening clinics. There have been drug shortages in Nigeria and Swaziland. Tanzania and Botswana are trimming treatment slots, according to a report by the medical charity Doctors Without Borders.

The collapse was set off by the global recession’s effect on donors, and by a growing sense that more lives would be saved by fighting other, cheaper diseases. Even as the number of people infected by AIDS grows by a million a year, money for treatment has stopped growing.

link: In Uganda, AIDS War Is Falling Apart – NYTimes.com

Medicynical Note: In fact, the emphasis on abstinence was wrong. It confused the education message and in doing so undermined the use of condoms as a mechanism to prevent spread. The “great success” of Uganda never was.

We now add to the continuing disastrous legacy of the Bush administration, the collapse of the anti-HIV campaign in Africa. Can you imagine starting a long term expensive treatment program that in addition to treatment forced the use of unproven prevention method, abstinence, without implementing a mechanism to pay for it. Amazing!



AIDS in Africa–We Have a Problem

It was hoped AIDS in Africa was being managed and controlled. Uganda’s victory lap appears to have been premature. It was the poster child for first ignoring the epidemic and later in managing it but now is in danger of “showing (us) how to lose the fight.”

It appears with the emphasis on treatment, prevention was deemphasized and/or mismanaged–the abstinence approach may well have failed. (not a big surprise) In addition the US is not increasing funding leading to question whether the “full $48 billion authorized by Congress by 2013” will be provided.

The challenge is enormous. Some 33. 4 million people worldwide have HIV, and under new guidelines by the World Health Organization, the number eligible for treatment has grown to 14 million, dwarfing the 4 million in treatment currently. Another 2.7 million people become infected each year. Those who don’t die first will eventually need to take antiretroviral drugs, a mixture of medications that helps the body suppress the disease and must be taken every day for life. The therapy, which doesn’t cure AIDS but allows people with HIV to live normal lives, means the number of people who need drugs will continue to grow.

One irony is that lifesaving medicine makes the prevention message harder to deliver. That much is clear in Uganda, once a leader in preventing the spread of HIV.

But the biggest distraction from prevention was likely the sudden flood of lifesaving drugs beginning in 2005. Fear of HIV dissipated as memories faded about the disease’s ravages. People gradually increased their number of sexual partners again. “Women are now more scared of getting pregnant than getting AIDS,” says researcher Phoebe Kajubi, who conducted a survey in a poor area of Kampala funded by the AIDS Prevention Research Project at Harvard University.

Medicynical Note: There are unintended consequences of introducing technology. The question is where do we go from here? We need a reinvigorated prevention/education program and less expensive medications. This is a medical emergency and patent holders should cooperate and provide generics to these countries.