AIDS is not a problem for Africa alone

AIDS is not a problem for Africa alone

Editorial AIDS is not a problem for Africa alone See Lancet 2005; 365: 1597 See Department of Ethics page 169 Predictably, Africa has dominated th...

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Editorial

AIDS is not a problem for Africa alone

See Lancet 2005; 365: 1597

See Department of Ethics page 169

Predictably, Africa has dominated the news and political agenda in the run up to the July 6–8 meeting of the G8 group of rich countries. Caught up in this momentum, news that WHO’s “3 by 5” antiretroviral treatment campaign is likely to miss its target—an admission spelled out in the June 29 WHO/UNAIDS progress report on the initiative—urged campaigners to pile yet more pressure on the G8 ministers in hopes of getting some overdue action. But the high profile of Africa’s dire problems overshadows some of the important revelations of the 3 by 5 progress report—and threatens to make the campaign against AIDS synonymous with the mass of other Africa-focused anti-poverty efforts. This must not happen. The WHO/UNAIDS report underscores Africa’s crisis: 76% of unmet need for antiretroviral treatment is in subSaharan Africa. But this dramatic statistic conceals the real hotspots of individual country burdens. Behind South Africa, India is the country with the highest number of those who need treatment, with an estimated 735 000 receiving no drugs.

Getting these individuals on antiretroviral therapy is made all the more difficult because AIDS policy in India did not support provision of antiretrovirals through the public health-care system until 2003; before then, the national AIDS programme focused solely on prevention. Even now, drugs are available in government-run hospitals in only six of India’s 28 states. The scale of the unmet need has an ironic twist: while India’s AIDS population waits patiently for access to treatment, the country’s booming generic drug industry, buoyed by the absence of patent protection before March this year, supplies medication to half the people on antiretroviral therapy in the entire developing world. In one respect, the 3 by 5 target has served its purpose. Numbers receiving treatment are on the rise and progress is accelerating. This trend will undoubtedly continue long after the 2005 deadline has receded into history. The threat now comes not from lack of momentum, but from an imbalanced global strategy. Africa is not the only continent struggling against AIDS. ■ The Lancet.

Psychotropic drugs: unhelpful and helpful comments

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See http://whqlibdoc. who.int/publications/2004/ 9241546417.pdf

See World Report page 111

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Is the actor Tom Cruise wrong to use his celebrity status to criticise psychiatry, as he has been doing in the past few weeks? He aimed some of his sharpest comments at actress Brooke Shields, who admitted in a recent book to taking an antidepressant for postpartum depression. Cruise, although sympathetic to Shields personally, professes to be a well-read expert in the “history of psychiatry”. He told Matt Lauer on NBC’s Today show that “psychiatry is a pseudoscience” with “ no such thing as a chemical imbalance”. In his views, he is reflecting the Scientology cult, of which he is an active member. He may be right that psychotropic drugs are overused, sometimes misused; and that lifestyle changes (and exercise for depression) can be helpful. But he is wrong, as a celebrity, to add to the burden of those with a mental illness, who often fear seeking or continuing treatment because of the stigma still attached to their condition. Shields responded fairly, writing last week in the New York Times, that Cruise’s comments are a “disservice to mothers everywhere”. The Global Burden of Disease study showed that mental illness accounts for over 15% of the burden of

disability in established market economies—more than that from all cancers. The study projected that psychiatric and neurological conditions could increase their share of the total burden of disease from 10·5% to almost 15% in 2020. But even getting psychotropic drugs is not simple, especially in the developing world. WHO tackled this problem in its report, Improving access and use of pyschotropic medicines. WHO’s essential drugs list for such drugs is seemingly of older medications, but they are chosen on grounds of efficacy, safety, and cost-effectiveness. Important for getting these drugs, says WHO, are mental-health policies that allow access and follow up, and legislation that promotes access. The report continues that any such drugs must be used appropriately, taking into account cultural and community beliefs, communication between patients and prescribers, and how drug information is disseminated. If you want to know what it is like on the frontline, see our World Report this week, about mental-health care in rural Costa Rica. ■ The Lancet. www.thelancet.com Vol 366 July 2, 2005