PARIS, July 17 (UPI) -- While world leaders spent this past week in Paris talking about creating a "war chest" to fight AIDS, in Soweto and Durban and Nairobi people just died, suffering and waiting in silence for the drugs that could have saved them.
The Global Fund to Fight AIDS, Tuberculosis and Malaria is crying for donations. Greece, a country of 10.6 million, has agreed to pledge only $250,000 for the campaign that is trying to save 7 million people from dying this year from the three epidemics.
As another 15,000 people -- mostly in Africa -- took their final, tortured breaths today, leaders of the global fund, meeting in conjunction with the 2nd International AIDS Society Conference, tried to round up capital to pay for projects in more than 90 countries.
Among the dead were people like Rwassa, a young African woman infected with HIV -- the AIDS virus. Her health began to deteriorate in 2001, but because she worked with an AIDS organization in Burundi, she knew of international promises by the wealthiest nations to fund treatments in the poorest nations. So she assumed their promises would be fulfilled.
She had hoped therapy would become available for her, said Dr. Marie-Josee Mbuzenakamwe of Bujumbura, Burundi, the young woman's colleague. She hoped the AIDS war chest would be funded to provide the antiretroviral medication she needed.
"The G8 countries have had no trouble making speeches that do justice to the seriousness of the epidemic," Mbuzenakamwe said in her keynote speech to the AIDS conference, and referring to the group composed of some of the world's economic powers -- the United States, Canada, Germany, Italy, Japan, the United Kingdom, France and Russia. "Not one of those countries has respected its commitments," she charged.
Rwassa held on until March 2002. "When she died she was still talking about the drugs that would come to save her life," Mbuzenakamwe said.
Those drugs did not arrive and the war chest remains unfilled.
This week, a delegation of Bush administration officials, headed by Tommy Thompson, the secretary of Health and Human Services and chairman of the board of the global fund, promised the money is coming as soon as Congress appropriates the funds -- perhaps by October 1, the start of the government's new fiscal year. The U.S. commitment, as outlined by Thompson, will include $200 million to $400 million for the global fund and at least $2 billion to fight AIDS and the other diseases in 14 countries.
That would be the first installment from President George W. Bush's promised -- and congressionally authorized -- $15 billion, five-year commitment. However, only $1 billion would go to the global fund, an amount economist Jeffrey Sachs, director of The Earth Institute and professor of health policy and management at Columbia University in New York City, said is woefully inadequate and disingenuous.
"Behind closed doors," he said, "the Bush administration has tried to dampen world enthusiasm to contribute to the global fund." The United States is limited by Congress to contribute one dollar to the fund for every two dollars donated by the rest of the world. By announcing America is willing to give $200 million to the fund, Sachs said, the administration signaled other international governments there was no need to contribute more than a total of $400 million.
Sachs told United Press International the United States and other wealthy nations excuse their underfunding of the war chest by comparing their efforts to previous failed attempts to provide help to poorer nations overburdened by disease. In response to Sachs' comments, Anthony Jewell, a spokesman for Thompson, said the Bush administration has done more to focus the U.S. government's attention on AIDS and to pledge more money than any previous administration or any other country in the world.
Nevertheless, few people in underdeveloped world have obtained access to the drugs that can save their lives, even though 90 percent of the disease occurs in those nations. AIDS persists not only because of lack of funds but because of barriers in the minds of bureaucrats and doctors who have allowed myths about treatment to prevail.
Jean-Paul Moatti, professor of economics at the University of the Mediterranean in Marseilles, France, said many of the difficulties of not getting drugs to underdeveloped countries involve these myths.
For example, he said, scientists have raised concerns that if patients do not adhere to their anti-retroviral treatment regimens, it could create worldwide resistant strains of HIV that could make fighting the disease worse.
Such worries ignore the evidence, Moatti said, "that demonstrate viral resistance and non-adherence to treatment are no greater problems in ... patients in Africa than in developed countries." He said the argument employs a double standard: The prospect of anti-retroviral resistance and non-compliance by patients are no barriers for treating rich Americans and Europeans, but somehow they are barriers to treating poor Africans and Asians.
The myth quoters, Moatti said, ignore studies in African countries such as Senegal and Uganda that have proven patients in poorer settings take their medication, just as they do in resource-rich countries.
For example, a new study examining resistance patterns in Europe concluded as many as 10 percent of new AIDS infections among Europeans are caused by viral resistance -- compared to only about 3 percent among African patients.
Moatti said because generic copies of anti-retroviral cocktails can lower the cost of drug treatments dramatically, which makes it cost-effective, even in the poorest of countries, to give the drugs to AIDS patients.
"Access to anti-retroviral therapy is not just a moral imperative," Moatti said. "It is good economic sense." He said treatment with the drugs will result in cost savings by keeping people out of hospitals. It also will prevent opportunistic infections from developing, thereby requiring more drugs as well as hospitalization.
He said one myth haunting delivery of drugs in Africa has been the debate over whether prevention and therapy can be delivered simultaneously. The fear is if people knew they could obtain treatment, they would not be diligent in trying avoid the disease. In fact, Moatti said his research shows treatment availability actually enhances testing, condom use and prevention measures.
"We have an economic rationale now," said Dr. Michel Kazatchkine, director of the Agence nationale de recherches sur le sida, the French national AIDS research organization.
"Three years ago people were still thinking we should go to prevention rather than treatment," he said. "Then people were saying the drugs were too expensive. Then people were saying the drugs were not cost-effective. Then people were saying we don't know if the drugs will be effective in the context of the developing world."
At this week's AIDS conference, Kazatchkine told UPI, "we believe we are bringing evidence to fight against all of these arguments."
Not that the fault lies entirely with the nations with money, Kazatchkine continued. "There are obstacles. There is insufficient commitment among those in the developed world and in the governments of underdeveloped nations."
For example, in South Africa, despite offers to provide drugs to prevent the transmission of the disease from pregnant mothers to their babies, treatment programs still are difficult if not impossible to find in Durban and the eastern part of the country, where the epidemic is greatest.
"There is insufficient coordination within the countries between the civil societies and the governments and the health sectors and financial sectors," Kazatchkine said at a news briefing. "There is insufficient manpower. But even with the available manpower we should be able to scale up treatment programs much better than we currently do."
The debate goes on, about the myths and about the money -- how much should be given to the global fund and when to give it. As the talk continues, so do the deaths: 3 million from AIDS each year, 2 million from malaria and 2 million from tuberculosis.
All are dying from diseases for which there are treatments.
Mbuzenakamwe said she lives with two realities: "One made of words, which is ultimately meaningless, for the words are not followed by results; and the other -- the one in which we live -- in which the numbers of deaths and infected people grow every day."
She predicted the global fund meeting would fail to provide meaningful additions to the global fund coffers. True to her prediction, the meeting failed to provide anything meaningful.
Millions of people in Africa and the rest of the underdeveloped world need action now. In the time it took to read this article, about 10 people in sub-Saharan Africa died from AIDS.
The speeches go on in Paris, in Washington and elsewhere. In Africa, the speeches are at the funerals of those who are dying while the rest of the world turns away.
