Global Health Experts Concerned Countries Not Prepared To Handle Influx of Funds To Treat HIV-Positive Individuals

Many world health advocates are concerned that they are not sure how to ramp up existing small-scale HIV/AIDS treatment programs in Caribbean and sub-Saharan African nations now that the "new reality in the fight against the killer pandemic is that once seemingly insurmountable financial barriers have fallen," the Boston Globe reports (Donnelly, Boston Globe, 5/19). The Senate on Friday approved by voice vote an international HIV/AIDS bill (HR 1298) that would authorize $15 billion over five years to fight AIDS in Africa and the Caribbean, including an amendment that would increase funding for debt relief in countries hit hardest by HIV/AIDS. The House earlier this month approved the measure, sponsored by Rep. Henry Hyde (R-Ill.), which would authorize $3 billion a year for five years to international HIV/AIDS programs, with up to $1 billion in fiscal year 2004 going to the Global Fund to Fight AIDS, Tuberculosis and Malaria (Kaiser Daily HIV/AIDS Report, 5/16). House Speaker Dennis Hastert (R-Ill.) said that the House would approve the Senate-amended version either tomorrow or Wednesday, the Wall Street Journal reports (Rogers, Wall Street Journal, 5/19). According to Richard Laing, an international health professor at Boston University who will soon join the World Health Organization, and other health experts, several countries in Africa, Asia and the Caribbean are "not prepared" to handle "huge infusions of money" to fight AIDS and do not have the necessary number of doctors, nurses and other health care workers they need to implement the new programs, according to the Globe. Also, the small treatment programs currently addressing HIV/AIDS in Africa have not created a basic set of recommendations for health workers about how to treat late-stage HIV and AIDS. Laing said, "We don't know when to start patients on therapy, we don't know when to change therapy if it isn't working, we don't know how necessary is it to know a patient's CD4 count or viral load," adding, "We do not know how to treat AIDS in Africa."

Learn As You Go
But some international health experts said that larger-scale programs should build on the smaller projects and "learn as they go," according to the Globe. Jonathon Quick, director of WHO's Essential Drugs and Medicines Policy, said, "It's a bit like cancer therapy in the early years: You begin with certain treatments, monitor them and make changes as you are treating." Nils Daulaire, president of the Global Health Council, said, "Has anyone done this at this scale? The answer is yes -- the Brazilian National AIDS Program has, although their numbers are certainly much smaller than what is going to be faced in the most highly affected areas in Africa." Some AIDS experts estimate that 4.1 million HIV-positive people in sub-Saharan Africa need antiretroviral treatment. Daulaire added, "Moving from pilot programs to wide-scale implementation is the brass ring in this whole process." Laing said that he believes the new money should be used to strengthen health care systems to ensure that proper care, treatment and prevention programs are begun. "You need to invest in people, distribution systems, and in simple, standard treatment regimens," Laing said. However, Andrew Fullem, senior HIV/AIDS adviser for the Boston-based public health consulting firm John Snow, said that public health systems cannot wait until infrastructures are fully developed or treatment protocols are written. "You're not going to have a perfect system from the get-go," he said, adding, "The days of talking about demonstration projects are over. Now we need to move with speed" (Boston Globe, 5/19).

A kaisernetwork.org HealthCast of a Senate Foreign Relations Committee hearing on fighting AIDS in Uganda, titled "Fighting AIDS in Uganda: What Went Right," including testimony from Anne Peterson, assistant administrator of the Bureau for Global Health at the U.S. Agency for International Development; Edward Green, senior research scientist at the Harvard Center for Population and Development Studies; and Sophia Monico, senior AIDS program officer at the Global Health Council, will be available online tomorrow by 5 p.m. ET.