AIDS Thrives in Poverty and Social Inequity

Versión en español

Thirty years of scientific research, hundreds of billions of dollars spent on prevention and treatment (PEPFAR alone, the U.S. President’s Emergency Plan for Aids Relief, spent 25 billion dollars from 2003 to 2008 on aid for a few poor countries) and they still have not been able to bring the AIDS epidemic under control. There must be something wrong with the policies pursued by international organizations to fight this tragedy.

For the first two decades of the epidemic, the primary strategy consisted of changing people’s behavior by promoting sexual abstinence, the use of condoms and reducing the sharing of needles by drug users. With the introduction of antiretroviral drugs, priority was given to medical and pharmaceutical responses, not only to treatment but also to prevention. Neither of these two strategies has been successful in stopping the epidemic; both approaches either deny the socioeconomic factor or relegate it to a secondary level of importance.

At the XVIII International AIDS Conference, held in Vienna in July of 2010, the call was to adopt “Treatment 2.0.” This plan consists of trying to simplify treatment, to widely expand testing for antibodies of the human immunodeficiency virus (the HIV test) and to offer universal access to antiretroviral drugs through a campaign that is to be run by governments in alliance with the pharmaceutical industry.

A similar initiative, called “3 by 5,” sought to provide access to antiretroviral treatments to three million new patients by the end of 2005. But despite the unified efforts of the World Health Organization, the United Nations, the World Bank and other organizations, by the end of the campaign only 18 out of the 152 countries participating in the program had been able to provide treatment to 50% or more of the patients diagnosed with HIV/AIDS. [1]

A study conducted in the United States by the Center for Disease Control (CDC), presented at the Vienna conference, provided sound evidence on the close correlation that exists between being diagnosed with HIV and living in areas of extreme poverty. According to the results there is no significant difference between the HIV prevalence rate among people living in zones of poverty in the United States and the HIV prevalence rate among people living in very poor nations such as Burundi, Ethiopia, Angola and Haiti. [2]

The implications of this report are clear: the policies and programs of prevention, care and treatment of HIV/AIDS that are implemented without simultaneously carrying out structural interventions aimed at reducing the conditions of poverty and social inequity are condemned to failure. And this raises another question: is it possible to provide universal access to treatment in countries where health systems restrict effective, timely and low cost or free access to comprehensive medical care for the entire population? And if poor patients were to have access, is it guaranteed that they will be able to follow the appropriate course of treatment? In countries such as Colombia with profoundly inequitable health care systems, the answer is NO; there’s evidence that the majority of Colombian women with HIV/AIDS who are uninsured or are covered by the subsidized plan of the healthcare system present low adherence to the treatment. [3] It is not uncommon that the poverty in which they live forces many of them to sell the antiretrovirals to provide food for their children.

Therefore it’s not surprising that Luc Montagnier, the Nobel laureate in Medicine who discovered HIV, would state in 2009 that the most efficient way to fight the epidemic lies not in drug treatments or in having a vaccine, but rather in combining these possibilities with a plan to guarantee vulnerable populations adequate nutrition, potable water and medical care. [4]