San Francisco Chronicle - Sunday, May 18, 2003
HIV infection continues to rise in Africa while mortality from HIV- related illnesses increases. Few African governments can be proud of their response to the epidemic. The South African government continues to dither in its AIDS policy, and for the first time since the end of apartheid, activist groups have used civil disobedience campaigns to provoke action. In Zimbabwe, President Mugabe irrationally focused on blaming homosexuals for AIDS rather than crafting an effective plan to confront the crisis.
Yet there are some countries that have faced this catastrophe admirably. Uganda's President Museveni showed bold political leadership and courage years ago by taking quick, effective action. His government promoted AIDS prevention and education, but also ensured that people had access to treatment, thereby reducing infection rates by 50 percent since 1992.
Botswana has the highest HIV infection rates in Africa and the world, with approximately 36 percent of the adult population infected. President Mogae's plan -- working with the Bill and Melinda Gates Foundation, the pharmaceutical giant Merck and other institutions such as Harvard University toward improving the health infrastructure, reducing infection and making sure that more people have access to essential drugs -- has borne positive results.
Other African leaders should learn that political will to fight AIDS goes far beyond wearing a red ribbon and making heartfelt speeches. African governments must end widespread corruption, so that drugs that are either donated or purchased cheaply go to those who require them and are not sold to the private sector. They must also ensure that drugs are not sold back into the European or American market, reducing the willingness of drug companies to make price reductions.
Political will also means that governments change their spending patterns. It is outrageous that the South African government claims it cannot afford to treat people with HIV/AIDS, but spends billions on armaments and a new jet for President Mbeki.
Antiretroviral drugs are needed in Africa; pilot projects have shown that in many instances they can be taken correctly and the regimens can be adhered to. But such efforts require enormous investment in health infrastructure and training. Moreover, no treatment program can be effective if it does not reduce the stigmatization of HIV-positive people, a situation that prevents many from seeking help.
While President Bush's announcement of a $15 billion plan to fight AIDS is welcome, it will not be easy to reach the stated goal of 2 million people on antiretroviral treatment without improving infrastructure. The few African success stories show that one of the best ways of doing this is to work with the research drug companies that have developed the medicines.
Nigeria recently experimented with generic antiretroviral drugs from India and this proved disastrous, with fewer than 10 percent of those intended to get drugs actually receiving them. Generic suppliers rarely provide the necessary pharmacological backup and advice that pharmaceutical companies offer in addition to drugs.
Despite the international unpopularity of the research pharmaceutical sector, it often does more for health care in Africa than most governments. Major research drug companies have donated billions in charitable donations and continue to research medicines for diseases like malaria. Humanitarian assistance is important, but continued research into new drugs is most critical. Governments can help by protecting these companies -- investments through strong intellectual property rights.
In the long term however, Africa must increase economic growth to ensure wealth creation in poor countries. Developed countries can help by reducing trade barriers. African leaders must also reduce corruption, protect property rights, promote rule of law and remove the economic barriers they have created (such as high taxes on health imports).
Africans are ill, unable to receive medical treatment and short of food because most African governments have kept people poor, frustrated trade and interfered with markets. By increasing economic freedom and enabling the private sector to thrive, Africa will be able to create the wealth that can build health infrastructure. Bush's billions of dollars are crucially important, but Africans won't triumph over AIDS or poverty until their leaders make a true commitment their people.
* Richard Tren is director of Africa Fighting Malaria based in Johannesburg.
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