A Glimmer of Hope from the AIDS Epidemic in Africa

From the WebMD Archives

Dec. 1, 2000 (Washington) -- Ten years from now is it possible that we will look back on the AIDS epidemic in sub-Saharan Africa and say that it saved more lives than it took?

If the crisis brings about the implementation of a modern health care sytem capable of treating not just AIDS, but countless other ailments, could there actually be a net gain in lives saved?

That possibility may seem far-fetched, considering the fact that on this, the 13th annual World AIDS Day, the disease already has claimed 14 million lives in Africa and another 25 million Africans are infected.

The glimmer of a silver lining, however, comes in a recent, little-noticed commitment from the World Bank, headquartered in Washington, to open its pocketbook on virtually an unlimited basis to help finance AIDS programs throughout sub-Saharan Africa. The bank has said that money should not be the obstacle to addressing the AIDS crisis.

That, according to a recent AIDS Epidemic Update from the U.N., is just what is needed. The 27-page report called for more financial aid for Africa, saying $3 billion a year could make a difference.

Of course, education still plays a role. The U.N. says the number of new HIV infections in Africa dropped this year for the first time, but that may have more to do with saturation of eligible victims than with safe sex procedures.

And, even in the world's richest countries, where money is somewhat less of an issue than in Africa, education remains needed. The U.N. says these countries are growing complacent, based on a perception that AIDS is over. In fact, there are as many new HIV infections in Western Europe and North America as 10 years ago.

But in Africa, at this point, money is the root of all survival. If the money is accepted by the African nations and if it is spent wisely, over the next decade we could witness a fundamental change in how health care is delivered in Africa. The money could be used to create within sub-Saharan Africa an infrastructure for delivering quality health care to people regardless of economic status.

If that occurs, then African nations will, in the long term, be stronger and better able to treat other diseases.

But the "ifs" are mighty big and mighty challenging.

African nations thus far have not been successful in effectively managing financial aid or offers of help from developed countries. For example, they have been reluctant to accept free drugs from pharmaceutical companies because they do not have mechanisms to distribute them efficiently. In many African countries, money that is infused into the system winds up in the hands of individuals and never achieves any results. When pharmaceutical companies donate money to support health care programs in Africa, they always set up their own structures or funnel it through private sector organizations.

Having been in South Africa for nearly three weeks this past summer during the International AIDS conference, I could see and understand what the drug companies have been saying for some time: that the infrastructure does not now exist for any African country to effectively fight AIDS, or any other major disease. Millions of people have no fixed addresses and no access to modern health care. Many still believe in herbal medicine, even to fight AIDS and cancer.

Now the World Bank is asserting its leadership by offering expedited, low-interest loans to countries in need. Recognizing that governments are at best inefficient and at worst corrupt, the bank has said it will insist that the money be spent by community groups or private organizations. That seems to make good sense.

If the money is indeed spent wisely and if health care delivery infrastructures are created in Africa, then perhaps in a decade we will be able to look back and see that some good came out of the AIDS tragedy that has enveloped the African continent.

Wayne L. Pines, WebMD's Washington columnist, is a former Associate Commissioner and Chief Spokesman of the Food and Drug Administration. The opinions expressed in this article are not necessarily those of WebMD.

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