AFRO-NETS> Save children, what about mothers and fathers? (6)

["Maija Palander" <maija.palander@tamgyn.inet.fi>]

Save children, what about mothers and fathers? (6)
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Dear all in Afro-nets!

I wanted to react on the topic of HIV-medication in the developing 
countries and especially after reading about the study in Botswana to 
reduce the vertical transmission and Dr. Johanne Sundby's question 
about the mothers (and why not also fathers?) and Gregg Gonsalves 
comment on it.
 
I am a gynaecologist working in Namibia, where it is estimated that 
about 20% of sexually active people aged 15-49 are HIV-infected. Also 
here there are sometimes people coming from neighbouring countries to 
preach that what Namibia cannot afford is not to treat HIV-infection, 
and definitely Namibia can afford to treat HIV-infection. Especially 
now when the prices of the drugs are getting lower there are many 
people and organisations that find it very difficult to understand 
why the medication is not offered to everybody.
 
I think that even with a free medication it would be impossible for 
many countries to treat all (or even many) HIV-infected people. The 
doctors and nurses prescribing and giving out medicines have to be 
trained for treating HIV. This is going to cost quite a lot and is 
going to need to get quite a lot of nurses and doctors to be relo-
cated from their posts. In many countries there is already now a lack 
of health professionals.
 
The medication needs quite a good follow-up with laboratory tests (at 
least CD4 cell counts, maybe viral loads, not to mention the more so-
phisticated tests used in developed countries). Many clinics and hos-
pitals are not equipped to carry out anything more than the basic 
tests. The cost of laboratory tests is going to be huge.
 
The medicines for HIV/AIDS are not without side effects. Treating the 
side effects is going to ask for more resources of the system. Many 
people live 10-30 km away from their clinics and hospitals with the 
only "vehicle" to travel being their own legs.
 
Many African countries can afford only about US$ 2-5 per year per 
capita on the health care. Of this they should pay vaccinations, 
treatment for malaria, ARI, diarrhoea, management of sexually trans-
mitted infections (which in my opinion would be one of the most ef-
fective ways to prevent HIV-infections), prevention of HIV, all the 
laboratory costs, operations, deliveries etc. etc. With which funds 
are the countries going to build an infrastructure to treat the HIV-
infected persons?
 
Millions of HIV-infected persons live in countries where the biggest 
problem is poverty. If I were HIV-infected Namibian and would get 
medicines, say for a week, worth of some money, and I had 5 hungry 
children at home, I would most probably sell the medicines and buy 
food. And this would be one of the best ways to create multi-
resistant HIV.
 
I wonder how all these questions are taken into consideration in the 
MTCT-Plus initiatives, which "are going to be launched soon". I have 
heard that at least some of these are planned to run for 1-2 years. 
Is this ethical?
 
Where are the funds for the treatment and infrastructure going to 
come from? From the prevention programmes? From vaccinations or from 
family planning and Maternity Clinics?
 
In some African countries there still seems to be prominent people in 
the Governments who think that a dead baby is better than an orphan. 
I couldn't disagree more. I am very happy about the Botswanan "monu-
mental" study to find out the best ways to protect the children at 
least. I want to congratulate the hospital officials in Mochudi, the 
people working with Moshi and the Harvard University. This study is 
in my eyes trying to solve at least one of the big problems in the 
enormous field of big problems with HIV/AIDS in Africa.
 
Dr. Maija Palander, Ob/Gyn
"Support to the Namibian fight against HIV/AIDS among children and 
adolescents" 
Project Co-ordinator
P.O.Box 86664, Windhoek-Eros, 
Namibia
mailto:maija.palander@tamgyn.inet.fi

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