[Pharm-policy] To Fight AIDS, Use Both Treatment and Prevention

[Gonsalves, Gregg]

Newsday (New York, USA) Editorial:
To Fight AIDS, Use Both Treatment and Prevention 
Jeffrey Sachs and Bill Gates-you guys need to sit down and talk. 
Last week Sachs, a Harvard economist, held a teleconference with journalists
to pitch his idea for a multibillion-dollar global trust fund to buy
life-prolonging AIDS drugs in poor nations where the epidemic is raging. It
was an important moment. So far, the world has watched with increasing
discomfort as costly new drug cocktails rejuvenate patients in rich nations
while millions of Africans face a swift death with no treatment at all. 
Two days later, Microsoft chairman and philanthropist Bill Gates, along with
leaders of other foundations, held a teleconference of their own. They gave
a nod to treatment, but stressed a need for more prevention programs. 
"I am concerned that all the pressure on treatment issues will squeeze out
prevention," asserted Tim Wirth of the United Nations Foundation. That
worries Gates, too. 
But here's the tricky part: If they are not careful, they could ignite a
destructive scuffle for dollars between treatment advocates and prevention
backers. In fact, the two responses are complementary and equally necessary.

Start with prevention. Certainly, the best and cheapest way to fight AIDS is
to make sure people never contract it. But how does a nation do that?
Uganda, Thailand and Senegal have reported successes as they strive to
convince citizens to modify their behavior. Most nations have botched the
job wretchedly. In the United States, the number of new infections has held
steady, at around 40,000 a year, since 1996. 
Meanwhile, the possibility of treatment makes it more likely that folks in
poor nations will get tested and counseled about responsible ways to live
with HIV. They are likely to enjoy added years of productivity. But
treatment is not a cure, and badly run programs can make the epidemic worse:
People who stop their therapy can create drug-resistant HIV. 
Sachs and Gates must take special care to avoid a noisy doctrinal debate. 
Resources are too scarce, AIDS moves too fast, and neither treatment nor
prevention by itself is an ideal answer. This battle requires teamwork. 




Gregg Gonsalves
Director of Treatment Advocacy
Gay Men's Health Crisis
119 West 24th Street
New York, NY 10011
Phone: 212-367-1169
Fax: 212-367-1235
Email: greggg@gmhc.org