US Policy and Public Health — AIDS in Africa

Over the last two decades, US policy makers have begun to debate the security implications of a non-traditional threat—the AIDS pandemic. The majority of this threat comes not from within the homeland, but from the regions of the world consisting of mostly developing countries. Today, Americans are faced with the major questions: Who is responsible for the public health of another nation? What role should the US play in fighting this pandemic? What are the social and economic consequences of continuing to provide limited resources for the prevention and treatment of HIV/AIDS positive populations in developing countries? How can the resources available be most effectively used? Are the current efforts addressing the societal causes of AIDS?

Thus far, with more than 70% of the worldwide HIV/AIDS infected population, Sub-Saharan Africa has been the most severely affected by the AIDS pandemic. The United Nations reports that 29.4 million children and adults are infected with HIV/AIDS in this region, with an estimated 3.5 million new infections and 2.4 million related deaths in 2002. Without massive efforts to increase prevention and improve treatment and care programs, the rate of infection and death toll are expected to continue rising throughout the next decade.

AIDS has, and will continue to have, severe economic and social ramifications in Africa. The World Bank estimates that the illness will slow and possibly reverse recent economic development in many countries. The Central Intelligence Agency (CIA) forecasts that the pandemic will provoke political destabilization and have serious security consequences when the infection of soldiers results in weakened military capabilities. According to many reports, food production and infrastructure will be affected by the death of farmers, skilled workers and teachers. The combination of these predictions over the last twenty years has led some US policy makers to support initiatives to combat HIV/AIDS in Africa.
Non-governmental organizations (NGOs) and governments of both African and non-African countries are attempting to reduce the infection rate, lessen the impact of AIDS on families, society and economies, while treating those infected with HIV/AIDS. Though these efforts have been supported by the US through grants, providing direct services and materials, and technology sharing—is the US doing enough? Are these efforts effective and efficient? To what extent does public health advances result in economic growth for these developing countries? To what extent are they requirements for economic growth?

The UN Secretary General estimates that $7 billion to $10 billion per year is needed to fight AIDS worldwide. According to the US Agency for International Development, the US has contributed a sum figure of over $2.3 billion to these efforts since 1986. Though the agency claims that the US has contributed more than any public or private organization in the world, many organizations calling for increased US funding cite the fact that the US contribution for FY2003 is only $510 million. On the other hand, many Americans respond to the international requests by pointing out that many Americans are continuing to become infected with HIV, while the federal government has provided essentially no new significant funding for domestic AIDS services in the last few years. With finite resources available, where is the money most effective and/or most needed?

The stipulations placed upon the utilization of monies and resources provided by the US are also a hotly debated issue. The past and present White House administrations have supported efforts aimed at preventing the spread of AIDS through research, education, testing, counseling, condom use, and reducing mother-to-child transmission. Critics, including former President Clinton who has changed his viewpoint since leaving the White House, advocate that treatment for the millions of people who are infected with HIV/AIDS is also required to provide humanitarian relief of suffering and to stop this pandemic—treatment, by allowing people to live longer, reduces the toll on the economy and society. With limited resources available, how can the need to prevent more infections and/or provide extended life to HIV/AIDS positive individuals be balanced? What factors outside of the AIDS disease must also be addressed to effectively prevent new infections? What role do conflict, poverty and malnutrition play in the spread of the pandemic?

The debate over increasing treatment programs brings up additional questions about the source and funding of medications and the challenges of implementing effective programs in developing countries that lack the required infrastructure. Much of the costly HIV/AIDS treatment and vaccine research and development has been conducted in the developed countries that have the required technical and monetary resources. The pharmaceutical industry in the US argues that to encourage the much-needed continued research by the industry, their patents and production rights must be protected. AIDS activists and foreign leaders call for anti-AIDS medications to be made available at a much lower cost than is currently available, if not for free. Should the US protect the domestic pharmaceutical industry to encourage future research? Should the US promise no trade repercussions for developing countries buying generic drugs? If AIDS medications are made available, do the developing countries have the needed infrastructure to correctly administer regimented therapy programs?

The AIDS pandemic is continuing to grow and, according to the CIA, will likely account for "the overwhelming majority of deaths from infectious diseases in developing countries by 2020." (The Global Infectious Disease Threat and Its Implications for the United States)

"The good news is that even the most severe HIV epidemic can be turned back, when HIV prevention and care are tackled seriously through community-wide efforts with the full support of governments, community organizations, religious institutions, and business. In every continent across the world, from cities and rural areas, we have examples of safe behaviors resulting in markedly lower HIV rates. The extension of access to care is slowly gaining momentum, and brings hope to millions." —Dr Peter Piot, UNAIDS Executive Director

-Submitted by:
Matt Berlin, Intern, Spring 2002
Liz Walsh, Education Program Coordinator