The silent tsunami

Nov 30th 2005
From The Economist Global Agenda

As the world marks AIDS Day, there are few victories to cheer, but ever more victims to mourn. Ambitious targets for spreading treatment have been missed by a mile

THE death toll of this disaster is now ten times larger than that of last year’s Indian Ocean tsunami. Some 3m people have died of AIDS-related diseases in the past year alone, a sixth of them children. These miserable statistics make a mockery of much-touted promises to be treating many more people for AIDS by now. Where the World Health Organisation (WHO) and UNAIDS hoped to see 3m people taking anti-retroviral drugs by the end of 2005—the widely trumpeted “3x5” initiative launched in 2003—barely a third of that number are now doing so. As a result, the silent tsunami is killing faster with each passing day.

In the run-up to World AIDS Day, on Thursday December 1st, the man in charge of the WHO’s efforts against the disease has said sorry for the failure to spread treatment. Jim Yong-Kim told the BBC this week: “All we can do is apologise…I think we have to just admit we’ve not done enough and we started way too late.” But he is hardly responsible for the collective failure. It has long been known that certain anti-retrovirals help tackle the symptoms of AIDS and prolong victims’ lives by many years. They are no longer expensive: basic therapies cost a few dollars a month. For those infected with the HIV virus in rich countries, they make it possible to live a normal life while avoiding full-blown AIDS. Those kept healthy are also likely to be less infectious, slowing the spread of the virus. But the pills are still not reaching most people who need them.

Some 40m people are probably infected with HIV—a population the size of Spain’s—and the greatest number are spread across parts of Africa where getting so much as an aspirin is tricky. Anti-AIDS drugs need to be taken daily and should be provided by trained nurses, kept within moderate temperatures and guarded from thieves. Ideally the patient should be monitored by doctors, blood samples regularly tested in laboratories, and treatment adjusted over time. In poor and hot countries, all that is proving hard to do. Even when they are available, the drugs should be taken on a full stomach, something the poorest in China, India and Africa too rarely enjoy. Even in middle-income countries with functioning health services, such as South Africa, rolling out treatment is proving slower and more painful than many hoped.

There are small victories to record. The Global Fund, an independent body that helps pay for anti-AIDS efforts, says the number of people getting the drugs from its programmes is rising fast, to some 380,000 today from barely half that a year ago. South Africa, after years of delay and government suspicion, now supplies anti-retroviral drugs—some produced from high-quality local factories—through its hospitals, though local activists complain that progress is still fatally slow. A small study in Belgium suggests one strain of the HIV virus, the one prevalent in Europe, may be weakening. In four countries previously seen as AIDS basket-cases—Burkina Faso, Haiti, Kenya and Zimbabwe—new figures describe a fall in the prevalence of HIV infection. However, this may be worse news than it seems, as the drop may merely reflect the fact that some of the infected are now dying very quickly.

Prevent it too

Though the battle against AIDS is increasingly about treatment, prevention matters too. Preventing the spread of HIV in the first place requires better education, wider use of condoms and finding ways to let women choose when—and when not—to have sex. China’s rulers this week said they would take the threat of AIDS more seriously, for example by doing more to stop HIV-contaminated blood being used by doctors. It would be even more useful if the authorities were honest about how many Chinese carry the virus: estimates range wildly, from 430,000 to 1.5m. India, which may now have more people infected with HIV than any other country, over 5m, hopes to educate more of its rural people about the disease.

What else could be done? A slew of reports has just been published by international organisations worried about AIDS. A vaccine would help dramatically, but there is no serious sign of an effective one yet, notes a study this week. More donor money might help roll out treatment and boost prevention efforts, but the need is all but endless: some $55 billion could easily be swallowed up in the next three years, suggested the UN recently. Better co-ordination of donor funds is crucial, added the World Bank this week. Paying for more nurses to be trained in poor countries would be especially useful, not least because so many health workers migrate to rich countries.

The final conclusion might still be optimistic: unlike a tsunami, this disaster is spread by human behaviour, and human behaviour can be altered. Lesotho, a tiny country in southern Africa, has just announced that every citizen will be tested for HIV and educated about the result. If all goes to plan, everyone should know how to avoid catching or spreading the virus, and then how to get treatment if needed.

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