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The AIDS Epidemic: Lessons Learned?
DISSECTING ROOM
LIFELINE Ainsley Newson Ainsley Newson is a PhD student in ethics and genetics at The Murdoch Institute in Australia. She is studying the ethical implications of behavioural genetics, specifically how behavioural genetic information should be interpreted by society, and whether it should be used to influence who is born. She has undergraduate training in genetics and law, and is currently a visiting researcher at Ethox, University of Oxford. Which research event has had most effect on your work and why? The cloning of Dolly occurred just as I was beginning to study bioethics. To me, this event and the ensuing explosion in academic and political literature has made ethics and genetics such an interesting and topical field to be in. Do you believe there is an afterlife? I would like to, but it is a hard concept to correlate with practical scientific training. What is your favourite book, and why? Jane Eyre by Charlotte Brönte—it showed me the value of an independent spirit—plus it was the only English essay I ever received an “A” for. What is your worst habit? It is a tie between stressing over the small things and procrastination. Do you believe in capital punishment? I would rather that society attempted to adopt a better preventative stance. What do you think is the most exciting field of science at the moment? Functional genomics, bioinformatics and pharmacogenetics—without these disciplines, the Human Genome Project will have no practical application. Do you apply subjective moral judgments in your work? Yes, my ethical opinion influences my research and writing—it is an inherent part of my methodology. interventions. If you had not entered your current profession, what would you have liked to do? I would have bought a pub somewhere and spent my days behind the bar listening to travellers’ stories.
1204
The AIDS Epidemic: Lessons Learned? e attended the 13th International AIDS Conference in Durban, South Africa in July where the unprecedented magnitude and impact of the AIDS epidemic in sub-Saharan Africa was clearly presented. Understandably, there was much discussion about equity in access to modern therapies, with considerable debate around different approaches to making them affordable to African nations. As a result of international pressures, pharmaceutical companies are donating millions of dollars and G-8 members are offering billions of dollars in credits to African countries for these drugs and improved health care. While there is a moral and ethical imperative to provide the best possible care, these efforts should not focus only on provision of antiretroviral drugs. Health systems throughout Africa are inadequately developed to provide them safely and effectively, and their inappropriate use can lead to worldwide proliferation of drug-resistant HIV strains. Hence, training of care providers, strengthening of laboratories and improvement of logistical and monitoring systems are essential. Drug donations are non-sustainable solutions to their availability and purchasing them through credits will increase the debt burden of African countries at a time when debt relief is essential to cope with this crisis. The best solution is differential pricing of these drugs between rich and poor nations. Prevention of maternal to child transmission through administration of these drugs to pregnant women shortly before delivery received much consideration in Durban. Unfortunately, it now appears that their benefit may be lost if infected mothers breast-feed their infants. Except for moderate progress in development of a preventive vaccine, there was much less attention given to other aspects of prevention, particularly to the reports of highly successful behaviour-based programmes in Uganda, Senegal, Zambia, Thailand, and Cambodia. In Uganda alone, HIV infection rates have dropped 50% over 5 years. These prevention programmes have three common features. First, they receive full commitment from the head of
W
state, hence ensuring resources and enabling AIDS to be discussed openly, reducing the stigma associated with the disease. Second, they involve a broad range of government sectors, an array of non-governmental organisations, and the private sector. Third, they are multifaceted, consisting of intensive, one-onone and group education of populations at risk, sex education in schools, condom social marketing, HIV testing and counselling, aggressive treatment of other sexually transmitted diseases, easy access to sterile needles and syringes, and social policy reform to reduce vulnerability. HIV prevention is cheap and highly cost effective. In highly infected populations it should be an integral component of care. In newly infected countries, like many in Asia and Eastern Europe where 60% of the world lives, it needs to start early to avert the greatest number of infections. To work effectively, sufficient resources must be made available; temptations to divert these towards immediate care needs must be resisted. The fact that $3 billion is currently required in subSaharan Africa alone for prevention and care, yet only $600 million is available to developing countries worldwide, means we have far to go to meet current needs. Many asked in Durban how the unfolding tragedy in Africa occurred. There are numerous reasons—the long interval between HIV and AIDS, the sexual route of HIV transmission, other pressing priorities on the continent, and benign neglect of Africa and its problems. Dire predictions on numbers of HIV infections and AIDS cases—all of which have come true—were either not believed or else ignored. The epidemic received appropriate attention only when millions more fell ill and their need for treatment became apparent. A more urgent question is whether those in Durban will attend an AIDS conference 10 years from now in India or China, facing an epidemic of even greater dimensions, asking how it could have happened again. This will depend on our commitment to HIV prevention. There is no greater priority for international health and development and little time is left to do what needs to be done. Michael Merson and Allan Rosenfield
THE LANCET • Vol 356 • September 30, 2000
For personal use only. Not to be reproduced without permission of The Lancet.
LIFELINE Ainsley Newson Ainsley Newson is a PhD student in ethics and genetics at The Murdoch Institute in Australia. She is studying the ethical implications of behavioural genetics, specifically how behavioural genetic information should be interpreted by society, and whether it should be used to influence who is born. She has undergraduate training in genetics and law, and is currently a visiting researcher at Ethox, University of Oxford. Which research event has had most effect on your work and why? The cloning of Dolly occurred just as I was beginning to study bioethics. To me, this event and the ensuing explosion in academic and political literature has made ethics and genetics such an interesting and topical field to be in. Do you believe there is an afterlife? I would like to, but it is a hard concept to correlate with practical scientific training. What is your favourite book, and why? Jane Eyre by Charlotte Brönte—it showed me the value of an independent spirit—plus it was the only English essay I ever received an “A” for. What is your worst habit? It is a tie between stressing over the small things and procrastination. Do you believe in capital punishment? I would rather that society attempted to adopt a better preventative stance. What do you think is the most exciting field of science at the moment? Functional genomics, bioinformatics and pharmacogenetics—without these disciplines, the Human Genome Project will have no practical application. Do you apply subjective moral judgments in your work? Yes, my ethical opinion influences my research and writing—it is an inherent part of my methodology. interventions. If you had not entered your current profession, what would you have liked to do? I would have bought a pub somewhere and spent my days behind the bar listening to travellers’ stories.
1204
The AIDS Epidemic: Lessons Learned? e attended the 13th International AIDS Conference in Durban, South Africa in July where the unprecedented magnitude and impact of the AIDS epidemic in sub-Saharan Africa was clearly presented. Understandably, there was much discussion about equity in access to modern therapies, with considerable debate around different approaches to making them affordable to African nations. As a result of international pressures, pharmaceutical companies are donating millions of dollars and G-8 members are offering billions of dollars in credits to African countries for these drugs and improved health care. While there is a moral and ethical imperative to provide the best possible care, these efforts should not focus only on provision of antiretroviral drugs. Health systems throughout Africa are inadequately developed to provide them safely and effectively, and their inappropriate use can lead to worldwide proliferation of drug-resistant HIV strains. Hence, training of care providers, strengthening of laboratories and improvement of logistical and monitoring systems are essential. Drug donations are non-sustainable solutions to their availability and purchasing them through credits will increase the debt burden of African countries at a time when debt relief is essential to cope with this crisis. The best solution is differential pricing of these drugs between rich and poor nations. Prevention of maternal to child transmission through administration of these drugs to pregnant women shortly before delivery received much consideration in Durban. Unfortunately, it now appears that their benefit may be lost if infected mothers breast-feed their infants. Except for moderate progress in development of a preventive vaccine, there was much less attention given to other aspects of prevention, particularly to the reports of highly successful behaviour-based programmes in Uganda, Senegal, Zambia, Thailand, and Cambodia. In Uganda alone, HIV infection rates have dropped 50% over 5 years. These prevention programmes have three common features. First, they receive full commitment from the head of
W
state, hence ensuring resources and enabling AIDS to be discussed openly, reducing the stigma associated with the disease. Second, they involve a broad range of government sectors, an array of non-governmental organisations, and the private sector. Third, they are multifaceted, consisting of intensive, one-onone and group education of populations at risk, sex education in schools, condom social marketing, HIV testing and counselling, aggressive treatment of other sexually transmitted diseases, easy access to sterile needles and syringes, and social policy reform to reduce vulnerability. HIV prevention is cheap and highly cost effective. In highly infected populations it should be an integral component of care. In newly infected countries, like many in Asia and Eastern Europe where 60% of the world lives, it needs to start early to avert the greatest number of infections. To work effectively, sufficient resources must be made available; temptations to divert these towards immediate care needs must be resisted. The fact that $3 billion is currently required in subSaharan Africa alone for prevention and care, yet only $600 million is available to developing countries worldwide, means we have far to go to meet current needs. Many asked in Durban how the unfolding tragedy in Africa occurred. There are numerous reasons—the long interval between HIV and AIDS, the sexual route of HIV transmission, other pressing priorities on the continent, and benign neglect of Africa and its problems. Dire predictions on numbers of HIV infections and AIDS cases—all of which have come true—were either not believed or else ignored. The epidemic received appropriate attention only when millions more fell ill and their need for treatment became apparent. A more urgent question is whether those in Durban will attend an AIDS conference 10 years from now in India or China, facing an epidemic of even greater dimensions, asking how it could have happened again. This will depend on our commitment to HIV prevention. There is no greater priority for international health and development and little time is left to do what needs to be done. Michael Merson and Allan Rosenfield
THE LANCET • Vol 356 • September 30, 2000
For personal use only. Not to be reproduced without permission of The Lancet.