Health - Commentary
 

The AIDS ‘tilt’

With this devastation so overwhelmingly affecting the developing world, the effort to fight AIDS is tilted just as overwhelmingly in the other direction, to the industrialized world. The most obvious example of this tilt is the new combination therapies, widely available in industrialized countries. The cost of these drugs—up to $15,000 a year per patient—is inconceivable to most people in the hard-hit nations. For the lucky few who could afford them, these therapies can be found only in middle-income countries like Brazil and Thailand; they are virtually unavailable in Africa. 

But other examples of the tilt abound. Of the $2.6 billion spent on HIV prevention efforts worldwide each year, only 14 per cent is spent in developing countries. These countries account for an even smaller proportion—6 per cent—of the $11.6 billion spent for care. Research on development of a vaccine, especially crucial in the hard-hit countries, gets less than 5 per cent of the $4.2 billion spent annually on HIV/AIDS research worldwide, according to most recent estimates. 

The historical lack of funding for vaccine development is scandalous and irrational, given what is at stake. However, there is encouraging news from the AIDS Research Evaluation Task Force of the US National Institutes of Health (NIH). 

AIDS is a development challenge, intermingling issues of poverty,
inequality, culture and sexuality in complex ways.

The Task Force, overseen and prodded by distinguished independent scientists, has called for a revitalization of the vaccine quest. NIH is now considerably increasing its vaccine efforts. In addition, a consortium of organizations has founded the International AIDS Vaccine Initiative to stimulate vaccine research. In particular, the initiative will support research targeted at HIV subtypes found in areas of the world where the disease is spreading most rapidly. Governments must also develop incentives to encourage serious investment on the part of drug companies in reaching this goal. 
 

Photo:UNICEF/92-1229/Sprague
Not only those who are infected with HIV suffer from the disease. As a mother sickens, care for children often suffers. Her daughter clinging to her, a young mother speaks with an AIDS counsellor in a poor neighbourhood of  São Paulo (Brazil).

Funding aside, the concentration of research in the industrialized world has other worrying implications. For instance, research on preventing mother-to-child transmission of HIV and on treating HIV-related conditions in children has been very limited, undoubtedly because these are largely problems of the developing world. Developing countries also need to be supported in building their own capacity to make AIDS medications available to their citizens who need them. It is imperative that the resources, the knowledge and the effort in fighting AIDS be spread more evenly around the globe. 

At the same time, more must be done to bring comfort to the lives of people sick from HIV-related illnesses. Painkillers, antidiarrhoeals, medicines to treat fungal infections—even these basic medicines are not affordable to people in the poorest countries. 
 
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