Zambia and AIDS
Aug. 14th, 2006 07:36 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
brdgt
AIDS Effort in Zambia Hailed as a Success
By LAWRENCE K. ALTMAN, The New York Times, August 14, 2006
TORONTO, Aug. 13 — Rapid expansion of a large AIDS treatment program in Lusaka, Zambia, is working well and has saved many lives in its first two years, the program’s leaders reported Sunday at the opening of the 16th International AIDS Conference here.
The report looked at the outcome for more than 25,000 patients who received antiretroviral drugs through the program, the largest group in a single program studied so far.
Only a few years ago, there was widespread skepticism that AIDS treatment programs would work in poor countries. The drugs were considered too costly and too hard to deliver to those who needed them; the required regimens were seen as too complicated and the side effects too dangerous.
But the effort has worked, the authors of the study said, as health workers have made intensive efforts to use in Zambia and other poor countries the same kinds of drugs and monitoring services that are standard in rich countries.
Reflecting those efforts, Bill Gates said at the conference Sunday night that there was “a new sense of optimism” in Africa because “the world is doing far more than ever before to fight AIDS.” Mr. Gates, the chairman of Microsoft, and his wife, Melinda, who have made stopping AIDS the top priority for their foundation, gave keynote addresses at the conference. They called for increased global access to H.I.V. prevention and treatment programs and greater efforts to dispel the stigma of AIDS.
Since the Zambian government opened 18 clinics in April 2004, death rates from AIDS have been reduced to compare favorably to those in the United States among patients who took standard antiretroviral drugs for at least three months, said Dr. Jeffrey S. A. Stringer, who led the team that reported the findings.
This group had 5 deaths for every 100 patient years (the number of patients multiplied by the number of years under treatment), in contrast to 4.34 at the University of Alabama at Birmingham, Dr. Stringer said at a news conference. Dr. Stringer works both at the university and at the Center for Infectious Disease Research in Zambia.
But treatment came too late for many AIDS patients in Lusaka. A vast majority of deaths occurred in the first three months of treatment.
Many dying patients “literally came in in wheelbarrows, a common form of ambulance in Lusaka,” the Zambian capital, Dr. Stringer said.
Now the challenge is to identify patients earlier in the course of the disease so they may benefit from antiretroviral therapy, Dr. Stringer said. But, he said, “getting patients to come in before they are deathly ill” will require Zambians to change their attitudes, particularly in breaking down the stigma of AIDS.
The Lusaka findings appear in the Aug. 16 issue of The Journal of the American Medical Association, which was released early to coincide with the opening of the AIDS conference. The meeting is expected to draw 24,000 participants.
Dr. Stringer cited four reasons for the program’s initial success.
One was the Zambian government’s leadership in promoting the program and its decision to eliminate medical fees for patients seeking H.I.V. care. The second was the use of nurses and physician assistants to compensate for a critical shortage of doctors. The third was use of a computerized system to monitor patients. The fourth was the large amount of money made available by the Bush administration initiative, the President’s Emergency Plan for AIDS Relief, a five-year, $15 billion program that serves 16 countries, 13 of them in Africa.
The costs of training staff and managing patients and workers exceeded the costs of the drugs (less than $300 a year for each patient) and the tests to monitor the drugs’ effect, Dr. Stringer said.
Dr. Peter Piot, the executive director of the United Nations AIDS program, said in an opening talk that the world must develop a sustainable plan to treat and prevent AIDS over the next several decades. “We must ensure that no credible national AIDS plan goes unfunded, now or in the decades ahead,” Dr. Piot said.
Mr. Gates said the world must vastly improve its efforts to prevent millions of new H.I.V. infections and to keep pace with the rapidly growing demand for treatment. “Treatment without prevention is simply unsustainable,” he said.
A more aggressive approach is needed to provide prevention tools to all who need them, Ms. Gates said. “Today, fewer than one in five of the people at greatest risk of H.I.V. infection have access to proven approaches like condoms, clean needles, education and testing,’’ she said. “That’s a big reason why we have more than four million new infections every year.”
In urging politicians to take stronger action to break down the stigma of AIDS, Ms. Gates said: “When Bill and I visit other countries, we are enthusiastically accompanied by government officials on all our stops — until we go meet with sex workers. At that point, it can become too politically difficult to stay with us, and our official hosts often leave. That is senseless.
“People involved in sex work are crucial allies in the fight to end AIDS. We should be reaching out to them, enlisting them in our efforts, helping them protect themselves from infection, and keeping them from passing the virus along to others. If politicians need a more sympathetic image to make the point, they should think about saving the life of a faithful mother of four children whose husband visits sex workers.”
By LAWRENCE K. ALTMAN, The New York Times, August 14, 2006
TORONTO, Aug. 13 — Rapid expansion of a large AIDS treatment program in Lusaka, Zambia, is working well and has saved many lives in its first two years, the program’s leaders reported Sunday at the opening of the 16th International AIDS Conference here.
The report looked at the outcome for more than 25,000 patients who received antiretroviral drugs through the program, the largest group in a single program studied so far.
Only a few years ago, there was widespread skepticism that AIDS treatment programs would work in poor countries. The drugs were considered too costly and too hard to deliver to those who needed them; the required regimens were seen as too complicated and the side effects too dangerous.
But the effort has worked, the authors of the study said, as health workers have made intensive efforts to use in Zambia and other poor countries the same kinds of drugs and monitoring services that are standard in rich countries.
Reflecting those efforts, Bill Gates said at the conference Sunday night that there was “a new sense of optimism” in Africa because “the world is doing far more than ever before to fight AIDS.” Mr. Gates, the chairman of Microsoft, and his wife, Melinda, who have made stopping AIDS the top priority for their foundation, gave keynote addresses at the conference. They called for increased global access to H.I.V. prevention and treatment programs and greater efforts to dispel the stigma of AIDS.
Since the Zambian government opened 18 clinics in April 2004, death rates from AIDS have been reduced to compare favorably to those in the United States among patients who took standard antiretroviral drugs for at least three months, said Dr. Jeffrey S. A. Stringer, who led the team that reported the findings.
This group had 5 deaths for every 100 patient years (the number of patients multiplied by the number of years under treatment), in contrast to 4.34 at the University of Alabama at Birmingham, Dr. Stringer said at a news conference. Dr. Stringer works both at the university and at the Center for Infectious Disease Research in Zambia.
But treatment came too late for many AIDS patients in Lusaka. A vast majority of deaths occurred in the first three months of treatment.
Many dying patients “literally came in in wheelbarrows, a common form of ambulance in Lusaka,” the Zambian capital, Dr. Stringer said.
Now the challenge is to identify patients earlier in the course of the disease so they may benefit from antiretroviral therapy, Dr. Stringer said. But, he said, “getting patients to come in before they are deathly ill” will require Zambians to change their attitudes, particularly in breaking down the stigma of AIDS.
The Lusaka findings appear in the Aug. 16 issue of The Journal of the American Medical Association, which was released early to coincide with the opening of the AIDS conference. The meeting is expected to draw 24,000 participants.
Dr. Stringer cited four reasons for the program’s initial success.
One was the Zambian government’s leadership in promoting the program and its decision to eliminate medical fees for patients seeking H.I.V. care. The second was the use of nurses and physician assistants to compensate for a critical shortage of doctors. The third was use of a computerized system to monitor patients. The fourth was the large amount of money made available by the Bush administration initiative, the President’s Emergency Plan for AIDS Relief, a five-year, $15 billion program that serves 16 countries, 13 of them in Africa.
The costs of training staff and managing patients and workers exceeded the costs of the drugs (less than $300 a year for each patient) and the tests to monitor the drugs’ effect, Dr. Stringer said.
Dr. Peter Piot, the executive director of the United Nations AIDS program, said in an opening talk that the world must develop a sustainable plan to treat and prevent AIDS over the next several decades. “We must ensure that no credible national AIDS plan goes unfunded, now or in the decades ahead,” Dr. Piot said.
Mr. Gates said the world must vastly improve its efforts to prevent millions of new H.I.V. infections and to keep pace with the rapidly growing demand for treatment. “Treatment without prevention is simply unsustainable,” he said.
A more aggressive approach is needed to provide prevention tools to all who need them, Ms. Gates said. “Today, fewer than one in five of the people at greatest risk of H.I.V. infection have access to proven approaches like condoms, clean needles, education and testing,’’ she said. “That’s a big reason why we have more than four million new infections every year.”
In urging politicians to take stronger action to break down the stigma of AIDS, Ms. Gates said: “When Bill and I visit other countries, we are enthusiastically accompanied by government officials on all our stops — until we go meet with sex workers. At that point, it can become too politically difficult to stay with us, and our official hosts often leave. That is senseless.
“People involved in sex work are crucial allies in the fight to end AIDS. We should be reaching out to them, enlisting them in our efforts, helping them protect themselves from infection, and keeping them from passing the virus along to others. If politicians need a more sympathetic image to make the point, they should think about saving the life of a faithful mother of four children whose husband visits sex workers.”
