Martha Khosa, RN  AIDS activist from South Africa

     African nations that have mounted successful campaigns to prevent transmission of HIV, such as Senegal and Uganda,  share two characteristics: 

1. effective national leadership that has sought to destigmatize and demystify  HIV/AIDS by openly discussing the disease in public, and  
2. the mass mobilization of many groups in society to carry out education projects that have taught their citizenry how to avoid infection by modifying their sexual behavior.

 Prevention is crucial for slowing the spread of HIV, but for over 25 million people living with HIV in Africa this message comes too late.

    Treatment must be made available to all people with HIV/AIDS regardless of their country of origin and ability to pay. Recent events in the United States leading to increased demand for the drug Cipro have made the U.S. government acutely aware of the need to obtain affordable drugs when faced with a public health crisis. In fact, the World Trade Organization's recent declaration issued after its meeting in Qatar stated that its agreement safeguarding patents and copyrights "does not and should not prevent  countries from taking measures to protect public health." Therefore, now is time to end the practice that prescribes anti-retroviral drugs for patients in developed countries or elites in the developing world, but tells the poor of developing countries that their only option is to prevent HIV infection. Seventeen million AIDS deaths in Africa are proof that what I tell you today is true.

    Mass mobilization of many groups has helped to prevent HIV transmission in Senegal and Uganda and mass mobilization will be necessary to provide anti-retroviral treatment to patients with AIDS. We know that Nurses and Doctors for World Health will not solve the AIDS crisis by themselves, the problem is too large. But  this organization will be part of the solution along with private citizens, governments, other NGOs, universities, and corporations all acting together.

    In addition to the HAART program you are proposing, I suggest that Nurses and Doctors for World Health initiate an anti-retroviral treatment program to prevent Mother to Child Transmission (MTCT) of HIV.  MTCT can occur in the womb, during childbirth or through breastfeeding. With no medical intervention, over one-third of mothers in developing countries will pass HIV to their babies. These programs, especially those using the anti-retroviral drug Nevirapine, are simple to administer and have been proven effective and safe enough for use outside of pilot programs. UNAIDS recommends that programs to prevent MTCT be included in the minimum standard package of care for HIV positive women and their children.

    Some callous individuals  believe that it is not worth saving the children of HIV positive women because they will grow up as orphans and perhaps become mercenaries and provoke political unrest. To these people I say the challenge is to improve the care we give to the innocent instead of abandoning them to a fate they do not deserve. For those not convinced by moral and ethical arguments alone, I remind them that children born in developing countries with HIV may live five years or longer. During this time these children will require medical treatment for the opportunistic infections they will suffer. In countries where medical care for routine problems is becoming increasingly difficult to obtain and where healthcare workers are burning out caring for AIDS patients, preventing MTCT is one way to decrease the pressure on national health care systems.

    I would like to conclude with a few words from a speech given by Benjamin William Mkapa, President of Tanzania, at the UN General Assembly Special Session on HIV/AIDS held in New York in June 2001. He said:

"The future of Africa depends on its people, including its young people, who are its most important resource. And today it is this very resource that is under the greatest and unprecedented threat. Under such circumstances, where does one draw the line between what is realistic and what is not? Tempered by the realization that it is the survival of human kind which is veritably at stake, no expectation can ever seem unrealistic, no river too wide to cross, no depths too deep to fathom and no heights too high to reach. Hannibal, one of the greatest military strategists of ancient times said: 'We must either find a way, or make one'. In the war on HIV/AIDS we too must find a way, or make one. For as the HIV/AIDS toll mounts we should not ask for whom the bell tolls; it tolls for all of us."

 

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Corelli, Epidemiologist