Rich nations leaving the poor to die of AIDS

In November, The Jakarta Post's Hera Diani joined 21 journalists from 17 countries at a one-week HIV/AIDS reporting workshop in New York, under the auspices of the Reuters Foundation. Below are reports from the workshop, which featured a number of high- caliber speakers, including top HIV/AIDS vaccine scientist Dr. Seth Berkley and economist Jeffrey Sachs, HIV/AIDS activists and health journalists, as well as MTV US producers who presented an HIV/AIDS awareness campaign directed at young people.

When he talked about his first professional encounter into AIDS issues in the mid-1990s in Africa, economist Jeffrey Sachs had a look of shock and bewilderment on his face.

"One of the things that I couldn't understand, truly, was how it seemed the disease had been de-medicalized, outside of the rail of medicine and public health," he addressed the workshop.

There was almost no spending for sick people, he said, and people were dying without any access to public health care whatsoever.

"What amazed me is that a lot of speeches have been given about AIDS, from the UN, World Bank and so on. I thought someone was doing something about it other than just giving speeches. And I found that wasn't the case," Sachs said.

The middle class was hardest hit at that time; doctors, nurses and farmers were lost to the disease and millions of children were orphaned.

"There was also the paradox of no spending at all to do something about it," he said.

Sachs and his team calculated the cost of health access for poor people and came up with the figure of US$3, which was being given for each infected individual per year in Africa in 1999.

The demand for more funding sparked anger from rich countries, which said it was not cost-effective.

"As if leaving 30 million people to die is cost-effective. The whole thing was a scandal. And it remains a scandal from top to bottom. Because rich people leave people to die on the planet," Sachs said.

Next year will mark 25 years since HIV was first diagnosed, and the epidemic continues to infect five million people a year, claiming three million lives annually. There are an estimated 40 million people worldwide now living with some stage of HIV or AIDS.

Sachs said that AIDS is part of a much general health crisis, which is part of a more general poverty crisis.

There is no effective health system in poor countries. The disease does more damage sooner because widespread hunger and undernutrition makes the body more susceptible to infection.

Some countries do not make the maximum effort with their meager budgets to provide an effective health system, but for most poor countries, the financial constraints are huge.

The health sector is deeply underfinanced and understaffed, with often one doctor for every 25,000 to 30,000 people, and one nurse for a ward of 70 to 100 patients.

According to Sachs, the cost of rich countries helping poor countries improve their health sector is about $25 billion per year. The figure, calculated in 2000/2001, is one tenth of 1 percent of the Gross National Product (GNP) of the rich world.

"That means if the rich world gave 10 cents out of every $100 of the GNP, that would translate not just into AIDS control, but malaria control, TB control, clinics, doctors, community health workers ... and we would save about eight million people per year from dying early of disease," Sachs said.

"Only 1/10 of 1 percent of the rich world's income."

Seems like a pathetically small amount of money, he said, but it is very, very hard politically because the rich countries are very strongly girded against helping the poor countries.

Many countries have not even carried out their promise to spend 0.7 percent of their gross domestic product (GDP) on AIDS, which means 70 cents of every $100 of GDP.

"There is strong resistance, particularly from the United States, and also from some other parts of the world. Europe is better, most tend to honor the obligation of 0.7 percent. The U.S. gives the smallest share of their national income to aid of any rich country. Just 0.16 percent of the GNP, while we spent 0.7 percent of the GNP on the war in Iraq," Sachs said.

With bird flu sparking a global bid to prevent a human pandemic, concerns have been raised over double standards in handling AIDS and avian influenza.

American Laurie Garrett, a leading medical journalist and Pulitzer Prize winner, said that while both avian flu and HIV/AIDS were pandemics, they were not treated in the same way.

"Suddenly Bush said it takes $7 billion for an avian flu pandemic, with half of that for pharmaceuticals and incentives (for the industry). There has never been such a big amount of money given for HIV/AIDS. Whereas we deal with a chronic disease phenomena, a contagious and ever-expanding disease. We've never been in a state of emergency for four decades," she said.

Top HIV/AIDS vaccine scientist Seth Berkley said that for every penny spent on avian flu, 10 times more than that should have been spent.

"It's too late, you should have done that 10 years ago. But the fact is we're going to buy Tamiflu for the United States and not worry about the rest of the world..

"While if the flu goes crazy in Africa, for instance, chances are the rest of the world is going to have it even if you do not care about Africa," he said.

Berkley pointed to the period right after Sept. 11 when there was an anthrax attack in the U.S., with four or five people infected. The U.S. government then stood up and said there should be compulsory licensing for every drug.

"Here was South Africa, sued by a different manufacturer because they said they wanted to provide antiretrovirals (ARV) to tens of thousands of people dying of AIDS. That's the kind of stuff that drives me crazy. That double standard is really a problem," Berkley said.