AIDS: I care..., do you?

AIDS: I care..., do you?

Chris W. Green, AIDS activist, Jakarta

That is the slogan accompanying this year's World AIDS Day,
which again falls on Dec. 1. Yes, I know it sounds a bit arrogant
-- but forgetting that, what does it really mean?

Interesting word, "care". Look it up in the dictionary and you
will find it has many different meanings. I guess those who
thought up the slogan intended it to mean "I feel concerned about
AIDS", or perhaps "I worry about AIDS". I like to think they also
hoped we would read it to mean that we were willing to care about
and care for people with Acquired Immune Deficiency Syndrome
(AIDS).

With 37 million people living with Human Immunodeficiency
Virus (HIV) and AIDS around the world, we can no longer just
mouth platitudes like "prevention is better than cure" --
particularly when there is no cure. Yes, prevention continues to
be very important, but many believe that it can only be effective
if it is integrated into care and support for those infected.

Given that HIV, the virus that causes AIDS, can only be spread
by those who are already infected, it seems obvious that those
who are infected should play a crucial role in the prevention
response. But this can only occur if they are aware that they are
infected. And because of the stigma and discrimination that a
positive diagnosis of HIV infection can bring, few of those who
feel they might be infected see any benefit in being tested. They
"know" that there is no cure for AIDS, and expect that they will
be left to die if it becomes known that they have the disease.
Who will care for them?

Until recently, many felt that there was little that could be
done for people with AIDS in the developing world. The new
treatments that started to become available in America and Europe
in the mid 1990s were far too expensive for all but a very small
handful of people with AIDS in the developing world. Who could
possibly raise the US$15,000 that was needed for one year's
supply of drugs -- and do that for life?

But over the last year, a breakthrough has occurred. With
competitive pressure from manufacturers of generic drugs in India
and Brazil, and strong advocacy from activists around the world,
these prices have dropped dramatically. Now, people with AIDS in
Indonesia can access this therapy for Rp 120,000 (US$11.5) per
month -- and there are hopes that even this cost can be reduced.
Already many are starting to take advantage of these low prices
-- and more are asking to be tested as a result.

But although HIV can infect both rich and poor, it tends to
affect disproportionately those in the bottom layers of society,
for whom even such relatively low costs are still out of the
question.

For example, we are seeing an explosion of HIV infection among
prisoners, primarily as a result of infecting drug use -- a
recent survey in a Jakarta prison showed that 17.5 percent were
HIV-positive. The prison authorities admit that their budget for
healthcare is Rp 700 per prisoner per year, enough only to buy a
few aspirin. How could they possibly offer effective treatment to
these people? Who cares?

But within one or two years, these prisoners will be released
and returned to the community. Will they care about infecting
others? Do they even know they are infected, or understand what
that means?

Evidence is accumulating that use of the new potent drugs can
depress the level of HIV in the body to a level that greatly
reduces the likelihood of transmission to others. Given that
persuading people to change their risky behavior, while not
impossible, is very difficult, offering this therapy can have a
significant effect on prevention.

Yesterday I received a call from Joyce Djaelani at the Yayasan
Kita drug recovery center in Bogor. They have been asked to take
in a young drug user who is showing symptoms of AIDS. The parents
have given up and just want him out of the house. Who cares?

Another junkie bites the dust... But, before he dies, the
chances are that he'll continue to share needles with others who
may not be infected. Caring for him could break that cycle of
infection. But where is the hospital willing to accept a current
drug user with AIDS?

Few enough are willing to accept people with AIDS, let alone
active drug users. I know, there are no easy solutions to this --
anywhere in the world. But who cares?

AIDS and drug use stretch our feelings of humanity to the
limit. Many of us find it difficult to empathize with drug users
or others whose behavior puts them at risk of HIV infection. But
is it not our society that has allowed the conditions to exist in
which such behavior occurs -- or even actively promoted them?

If we are to make any impact on the spread of this epidemic,
we must care about AIDS -- and care for those infected.