Treatments available to help people suffering from AIDS

By Chris W. Green

JAKARTA (JP): Most people are aware that AIDS (acquired immune deficiency syndrome) is an incurable disease -- indeed this is probably the only correct bit of information that most people do know about AIDS. But like several other incurable diseases such as diabetes or some heart conditions, there are treatments available. These can turn AIDS into a "chronic" condition, allowing life to continue relatively unaffected by the disease.

First, let's remember that AIDS is a syndrome, or collection of conditions, resulting from an infection by the human immunodeficiency virus (HIV). There are many human diseases that are caused by viruses, perhaps the best known being influenza. Medical science has yet to find a cure for diseases caused by viruses; all that can be done is to prevent infection by vaccination. Nature is much cleverer: the body's immune system can overcome most viral infections if it is working properly. And it could probably do the same for AIDS, but for the fact that HIV works like a fifth column, actually infecting the immune system. The immune system does its best to resist but finally it becomes so weak that it can no longer control infections. This is the condition known as AIDS. For most people, it takes 10 or more years after infection to reach this stage.

The main treatments currently available reduce the rate at which HIV weakens the immune system, in many cases they appear to prevent the progression to AIDS. "Appear", because the treatments have only been available for about five years, and no one knows of their long-term effects yet.

That's the good news. There are a number of associated bits of bad news. Among these, the current treatments are difficult to undergo, sometimes requiring patients to take as many as 20 pills a day, following a difficult schedule, some with food, some without. And they are unforgiving; missing a dose on more than a few occasions can impair the effectiveness of the treatment, such that the treatment must be replaced by another, sometimes with one which is even more complicated.

But even worse is the cost. This can be more than one thousand US dollars a month! In the developed world, government health services and insurances usually cover this. Such an expense is clearly way beyond the means of people or governments in much of the developing world, where 90 percent of people with AIDS live. Efforts are being made to find ways to reduce this cost substantially, and there is hope that it can be reduced to less than a hundred dollars a month in the near future. But of course even this steep discount would still leave the treatments out of reach of most people in countries like Indonesia where the annual per capita expenditure on health is less than five dollars.

Happily, this is not the complete end to the story. Although few may be able to afford the drugs to turn AIDS into a treatable condition, much cheaper medicines are available to prevent and treat the infections which occur as a result of AIDS. Many of these infections, such as TB or forms of pneumonia, are caused by common bacteria. These can be prevented by preemptively taking common and cheap antibiotics, which should be available in all community health centers (puskesmas) in Indonesia. The same drugs can be used to treat the diseases should they occur.

Import

Fungal conditions are also commonly associated with AIDS, and these can also be treated. Although currently the best drug for fungal infections is under patent and very expensive, a cheaper generic version is already being produced in India at less than one tenth of the price of the brand-name version. Such action is allowed under World Trade Organization (WTO) rules with compulsory licensing, and Brazil and Thailand are also producing similar drugs under this approval. It should be possible to import these generic versions into Indonesia under the WTO regulations. Sadly, but perhaps not surprisingly, large multinational drug companies oppose such initiatives, and use any approach to frustrate them.

But there are challenges even to this basic method of treatment. Because only a relatively small number of people have been identified as infected with HIV in Indonesia (about 2000 people at the end of 2000), few doctors have any real knowledge of how to treat these AIDS conditions -- indeed AIDS is rarely diagnosed even at the late stages of the disease. And people who know they have been at risk of infection are often unwilling to be tested. They question the value of knowing their status, fearing stigmatization and discrimination, with no apparent benefits in terms of treatment.

This unwillingness to be tested has a negative impact on prevention activities -- those who are aware that they are infected are more likely to take precautions to avoid infecting others. Further, as peer educators, they can make invaluable contributions to prevention programs. We therefore need to search for any incentive that will help persuade such people to be tested.

In Indonesian, an "incurable" disease is often translated as one "without a treatment". For AIDS, this is an incorrect statement. It is very important for us to attack the counsel of despair by getting the message out that even with limited funds, people with AIDS can take action to increase both the quality and quantity of their lives.

The writer is an AIDS activist.