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Putting a Plague in PerspectiveBy DANIEL HALPERINPublished: January 1, 2008

Cambridge, Mass.

 

Enlarge his I!age

 ALTHOUGH the United Natins recentl! l"ered its glbal H.#.$.

estimates, as man! as %% millin peple "rld"ide are still living

 "ith the A#&' virus. This pandemic re(uires cntinued attentin)

preventing *urther deaths and rphans remains imperative. +ut the

 "ellmeaning prmises * sme presidential candidates t utd

even President +ush-s prpsal t nearl! duble American *reign

assistance t *ight A#&' strie me, an H.#.$.A#&' specialist *r /0

 !ears, as missing the mar.

'me have critici1ed Mr. +ush *r re(uesting 2nl!3 4%5 billin *r

the ne6t *ive !ears *r A#&' and related prblems, "ith the leading

&emcratic candidates having pledged t cmmit at least 405 billin

i* the! are elected. 7et even the current 4/0 billin in spending

represents an unprecedented amunt * mne! aimed mainl! at a

single disease.

Mean"hile, man! ther public health needs in develping cuntries

are being ignred. The *act is, spending 405 billin r mre n

*reign health assistance des mae sense, but nl! i* it is nt

limited t H.#.$.A#&' prgrams.

Last !ear, *r instance, as the United 'tates spent almst 4% billin

n A#&' prgrams in A*rica, it invested nl! abut 4%5 millin in

traditinal sa*e"ater pr8ects. This nearl! /55t/ imbalance is

disastrusl! ine(uitable 9 especiall! cnsidering that in A*rica

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H.#.$. tends t be mst prevalent in the relativel! "ealthiest and

mst develped cuntries. Mst A*rican natins have stable adult

H.#.$. rates * % percent r less.

Man! millins * A*rican children and adults die * malnutritin,pneumnia, mtr vehicle accidents and ther largel! preventable, i* 

nt headlinegrabbing, cnditins. One*i*th * all glbal deaths

*rm diarrhea ccur in 8ust three A*rican cuntries 9 Cng,

:thipia and Nigeria 9 that have relativel! l" H.#.$. prevalence.

 7et this cnditin, "hich is nt particularl! di**icult t cure r

prevent, gets scant attentin *rm the dnrs that invest nearl! 4/

 billin annuall! n A#&' prgrams in thse cuntries.

# "as struc b! this discrepanc! bet"een ;estern dnrs- pririties

and the real needs * A*ricans last mnth, during m! mst recent

trip t A*rica. #n 'enegal, H.#.$. rates remain under / percent in

adults, partl! due t that cuntr!-s earl! adptin * enlightened

plicies t"ard prstitutin and ther ris! practices, in additin t

universal male circumcisin, "hich limits the heterse6ual spread * 

H.#.$. <ates * tuberculsis, n" anther *avred disease *

internatinal dnrs, are als relativel! l" in 'enegal, and # learned

that even malaria, the dnrs- third ma8r cncern, is nt (uite as

rampant as "as assumed, "ith ne" testing *inding that man! *evers

aren-t actuall! caused b! the disease.

Mean"hile, the stench * se"age permeates the cr"ded utsirts * 

&aar, 'enegal-s capital. There, as in man! ther parts * ;est

 A*rica and the develping "rld, inade(uate access t sa*e "ater

results in devastating diarrheal diseases. 'hrtages * *d and basic

health services lie vaccinatins, prenatal care and *amil! planningcntribute t large *amil! si1e and high child and maternal

mrtalit!. Ma8r dnrs lie the President-s :mergenc! Plan *r

 A#&' <elie*, n"n as Pep*ar, and the Glbal =und t =ight A#&',

Tuberculsis and Malaria have nt directl! addressed such basic

health issues. The Glbal =und-s directr, Michel >a1atchine, has

acn"ledged, 2;e are nt a glbal *und that *unds lcal health.3

+ts"ana, "hich has the "rld-s mst lucrative diamnd industr!

and is the secnd"ealthiest cuntr! per capita in sub'aharan

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 A*rica, is n"here near as burdened as 'enegal "ith basic public

health prblems. +ut as ne * a d1en Pep*ar 2*cus3 cuntries in

 A*rica, this !ear it "ill receive abut 4%55 millin t *ight A#&' 9 in

additin t the hundreds * millins alread! granted b! drug

cmpanies, private *undatins and ther dnrs. ;hile in thatsparsel! ppulated cuntr! last mnth, # learned that much * its

 A#&' mne! remains unspent, as even its state*theart H.#.$.

clinics cannt absrb such a large in*lu6 * cash.

 As the United 'tates Agenc! *r #nternatinal &evelpment-s H.#.$.

preventin adviser in suthern A*rica in ?550 and ?55@, # visited

 villages in pr cuntries lie Lesth, "here clinics culd nt a**rd

t stc basic medicines but *ten maintained an inventr! *e6pensive A#&' drugs and sphisticated mnitring e(uipment *r

their H.#.$. patients. H.#.$.in*ected children are **ered e6emplar!

treatment, "hile children su**ering *rm much simplerttreat

diseases are le*t untreated, smetimes t die.

#n A*rica, there-s anther crisis e6acerbated b! the rigid *cus n

 A#&' the best health practitiners have abandned l"erpa!ing

psitins in *amil! planning, immuni1atin and ther basic health

areas in rder t "r *r dnr*inanced H.#.$. prgrams.

The A#&' e6perience has demnstrated that pr cuntries can

mae cmple6 treatments accessible t man! peple. <egimens that

are much simpler t administer than antiretrviral drugs 9 lie

antibitics *r respiratr! illnesses, ral reh!dratin *r diarrhea,

immuni1atins and cntraceptin 9 culd als be made "idel!

available. +ut as there isn-t a 2glbal *und3 *r sa*e "ater, child

survival and *amil! planning, cuntries lie 'enegal 9 and evenprer nes 9 cannt directl! tacle their real prblems "ithut

pegging them t the big three diseases.

T their credit, sme A#&' advcates are calling *r a brader

apprach t internatinal health prgrams. Amng the presidential

candidates, 'enatr +arac Obama, *r e6ample, prpses t g

 be!nd spending *r A#&', tuberculsis and malaria, highlighting

the need t als strengthen basic health s!stems. And recentl!, Mr.

+ush-s plan, alng "ith the Glbal =und, has becme sme"hat

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mre *le6ible in supprting ther health issues lined t H.#.$. 9

thugh this "ill be * little use t peple, especiall! utside the

2*cus3 cuntries, "h are d!ing * cmmn illnesses lie diarrhea.

+ut it is als imprtant, especiall! *r the United 'tates, the "rld-slargest dnr, t ree6amine the epidemilgical and mral

*undatins * its glbal health pririties. ;ith /5 millin children

and a hal* millin mthers in develping cuntries d!ing annuall! *

largel! preventable cnditins, shuld "e mutipl! A#&' spending

 "hile giving nl! a pittance *r initiatives lie sa*e"ater pr8ectsB

#* ne "ere t as the peple * virtuall! an! A*rican village utside

sme /5 cuntries devastated b! A#&'D "hat their greatest cncerns

are, the ans"er "uld undubtedl! be the less sensatinal but mre

ubi(uitus ravages * hunger, dirt! "ater and envirnmental

devastatin. The real"rld needs * A*ricans struggling t survive

shuld nt cntinue t be subsumed b! the *avrite causes du 8ur * 

 "ellmeaning !et *ten unin*rmed ;estern dnrs.

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