[Mb-civic] How to Turn The Corner On AIDS - Jim Yong Kim - Washington Post Op-Ed

[William Swiggard]

How to Turn The Corner On AIDS

By Jim Yong Kim
Wednesday, November 23, 2005; Page A19

A new U.N. report shows that the global AIDS epidemic has been cutting a 
broad and destructive path, causing 3 million deaths in the past year 
alone, or 60,000 a week. Nearly half of the 40 million people living 
with HIV-AIDS are women, and more than 2 million are children. Infection 
rates are rising in nearly every region of the world.

Why, then, in the face of numbers such as these, are some public health 
officials, myself included, optimistic that the epidemic can be stopped? 
Because there is a growing body of evidence that public health 
approaches such as pairing HIV treatment and prevention and 
strengthening health care delivery systems in poor countries can help 
not only slow HIV-AIDS but also make long-needed breakthroughs in 
reducing the impact of diseases such as malaria and tuberculosis that 
enslave the developing world.

The good news is hard to find in the new U.N. report, but it's there. 
While the number of AIDS deaths continues to rise, the rate of increase 
is slowing, probably because a growing percentage of people in need now 
have access to HIV treatment. The World Health Organization reports that 
between 250,000 and 350,000 deaths were averted last year because of 
expanded access to treatment. More governments are moving to reduce the 
global HIV death rate by strengthening the health systems that deliver 
AIDS care. But this effort is proceeding at a maddeningly slow pace that 
must be stepped up.

Expanding access to treatment is only half the picture, however. The 
other critical and equally difficult challenge is reducing new HIV 
infections, which reached 5 million last year. This is no easy task, 
considering that the United States, with all of its education and 
technology, has not been able to reduce HIV infection rates in more than 
10 years. When you consider that, globally, fewer than one in five 
people at risk of HIV infection has any access to HIV prevention 
information, it becomes clear that a new approach is required.

That approach must go beyond AIDS awareness billboards, abstinence 
education and condom demonstrations. All these have their place, but 
none has produced the sustained reductions in HIV infections needed to 
tip this epidemic. The approach that excites public health advocates, 
and that seems increasingly achievable, is building and strengthening 
health care systems in the developing world so they can deliver both HIV 
treatment and prevention, including voluntary counseling and testing.

Before treatment became available in the developing world, governments 
had little reason to invest in HIV testing, and individuals had no 
reason to know their status. Today, however, access to treatment is 
driving new interest in HIV prevention and testing among governments and 
individuals. In one region of South Africa, demand for voluntary HIV 
testing and counseling increased by 1,200 percent when treatment became 
available. The interest and excitement created by the growing 
availability of HIV care must be marshaled to support the building of 
health care systems that provide not only HIV services but also 
education and testing for other diseases that facilitate HIV 
transmission and exacerbate AIDS, such as malaria, TB and sexually 
transmitted infections.

Creating basic health care in poor countries is challenging but far from 
impossible. The World Health Organization and national governments have 
developed service delivery models that work with reduced numbers of 
trained health care workers and without expensive equipment or 
diagnostic tests. There is increasingly compelling evidence that more 
good can be done with a limited health system than was thought possible.

Governments in some of the world's poorest nations, seeing the potential 
to improve their health care systems, are becoming more willing to 
invest the resources and political will needed to manage their HIV 
epidemics and other health crises. Take Lesotho, a small, southern 
African nation of 2 million people, where about one in three adults is 
HIV-positive. Lesotho will soon offer HIV counseling and testing to 
every citizen, within a framework that protects confidentiality and 
provides access to care. Nearby Swaziland, where four of 10 adults are 
infected, provides HIV treatment to more than half its citizens in need, 
an enormous undertaking that other nations must emulate. The Swazi 
government aims to deliver quality HIV-AIDS prevention, treatment and 
care services in 80 percent of health care facilities by the end of 2007.

It would be inaccurate to say that we are close to turning back this 
epidemic. Current efforts to provide HIV treatment, intensify prevention 
and strengthen health services are scattered and lack the pace and 
rhythm needed to make a global impact. If we coordinate efforts, 
however, to strengthen the health care systems that can holistically 
address prevention and treatment of HIV-AIDS and the other debilitating 
diseases of the developing world, there is reason to believe that we can 
turn a corner on this and other epidemics.

http://www.washingtonpost.com/wp-dyn/content/article/2005/11/22/AR2005112201363.html
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