To fight AIDS we must focus on more than treatment

In the world of the aid industry, the only lesson of failure is: we need more money. So World AIDS day is being used as a call for more cash to prop up failing programmes and strategies. Delivery of drugs is a major problem of treatment but the real answer lies in prevention.

The World Health Organisation announced in 2003 that it would put three million people on antiretroviral (ARV) drugs by the end of 2005 -- the "3 by 5" program: at the time at least six million people were known to need ARVs, with many millions more not yet diagnosed. Tragically, because treatment was given priority over prevention, another five million people have become infected with HIV this year alone--with only a million people on ARVs. "Worst hit is sub-Saharan Africa. With 28.5 million people infected, HIV/AIDS has destroyed communities, health care systems and put a shadow upon the future of entire countries," the WHO said in 2004. It is now worse.

But as ex-President Clinton said: "You just can't get the medicine, ship it into a country, and drop it from the sky… If it is going to save people's lives, the medicine must be accompanied by instructions, monitoring, by follow-up, and changing the medicine if necessary."

Worse, there is a danger that in obsessing over treatment of HIV/AIDS, other curable diseases will be left by the wayside: diarrhoea, malaria, tuberculosis and pneumonia kill far more people, weaken more immune systems and therefore also contribute to the spread of AIDS.

In July the G8 leaders announced they wanted to ensure universal access to ARVs by 2010. But if this were achieved overnight it would still not halt the spread of AIDS: the longer you live with HIV, the longer you live to infect others, to develop resistant strains and to give birth to infected children.

Some 20 per cent of HIV patients in Kenya have already developed resistance to the ARVs that keep full-blown AIDS at bay. "The situation is already running out of hand," Dr Jacob Joseph, of Nairobi's Coptic Hospital, the biggest supplier of ARVs in East and Central Africa, said in August this year.

There is no cure for HIV, only palliatives, and a vaccine is still a long way off. Even David Margolis, claiming a breakthrough in early August at the University of North Carolina, cautioned: "I don't expect it to happen soon. In the meantime prevention has to be the key message."

Only prevention can break the vicious circle but it is a long, hard campaign to improve living standards, to educate people about all forms of sexually transmitted disease and to change sexual behavior, promoting abstinence, being faithful and using condoms (dubbed the ABC program).

Brazil is often cited as a success, keeping the level of infection down around 0.5 per cent of its population with a combination of treatment and prevention, involving education campaigns, advertising and free condoms. But Brazil has 206 doctors per 100,000 people while Africa, the hardest-hit continent, averages 12.5 doctors per 100,000 with correspondingly poor medical infrastructure.

Uganda is one of the few African countries where the level of HIV has apparently declined: its prevention policies are credited with bringing the level down from 15 per cent in the early 1990s to 5 per cent in 2001 - although in fact that is mainly due to victims dying, as there is no cure. Few national estimates are reliable but a recent local count of infected pregnant women in Kampala did show a drop of two-thirds, indicating that the rate of new infection may have fallen.

Sex education programs in schools and on the radio have apparently boosted condom use since 1990 from 7 per cent nation-wide to over 50 per cent in rural areas and over 85 per cent in urban areas.

So it can be done, slowly but effectively, even in a country beset by civil war, armed bands and poverty.

To really tackle disease, Africa needs to become richer. Wealth and health are directly linked: bad water, smokey cooking fuels, poor food and inadequate shelter breed disease. Intestinal worms, guinea worms, schistosomiasis, trachoma, cholera, typhoid, hepatitis A and dysentery affect at least half a billion poor people; another half-billion people suffer from water-related diseases, such as malaria and dengue fever; 400 million have chronic hepatitis B. All these make poor people more susceptible to HIV infection and the development of AIDS symptoms.

And the only way to achieve greater wealth is through economic freedom: decentralized ownership of resources, respect for private property and the rule of law. Simply put, it means allowing individuals to make their own lives better in every way.

Instead, Africa is plagued with corrupt and statist regimes that have absorbed $450 billion in aid over the last 30 years, leaving Africans poorer now on average than they were 20 years ago--and more than a third of Africans have lower life-expectancy than they did 20 years ago, World Bank figures show. Most African countries deny farmers title to their land and restrict internal as well as external trade, even imposing tariff barriers on drugs and other health commodities.

Only economic freedom can launch the virtuous circle of progress in wealth and health: given the chance, Africans are perfectly capable of improving their own lot. This is the powerful prescription for preventative health in the battle against diseases of every kind, including HIV/AIDS. Franklin Cudjoe is Director of Imani, a policy think-tank in Ghana Send him an email at [email protected]