[afro-nets] No ARV roll-out is better than a bad ARV roll-out (4)

[J Mark Adams <j.mark.adams@iafrica.com>]

No ARV roll-out is better than a bad ARV roll-out (4)
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On Mon, 12 Apr 2004 Wendy Holmes <holmes@burnet.edu.au>
wrote:
 > When so many people are dying it is understandable that people
 > get upset and frustrated about the inequality of access to
 > anti-retroviral drugs. But it is important not to be blindly
 > critical of the analysis of others with experience who are
 > trying to alert policy makers to potential dangers.

I truly wish it was as simple as that.


 > Peter Barron is not a fool, and is certainly not arguing
 > against provision of ARVs.

Well if he is not a fool then he is indeed a "useful idiot". A
"useful idiot" in the respect that he is playing along with
Mbeki's game of "delay is the best form of denial".


 > In fact he concludes: "We have to have a national ARV pro-
 > gramme, but we have to do it the right way and with the right
 > level of commitment and capacity."

And does our Peter Barron really believe there will ever be "the
right level of commitment" from Mbeki and his underlings? And of
course given the lengths Mbeki has gone to delay and confuse the
whole issue of roll out does he or anyone think there is an in-
centive to do it right and to provide the funding to ensure the
capacity?


 > He is on the same side - so there is no need to fight him.

Which side is that? Mbeki's? He is certainly not on the side of
the 5m that need the treatments and the 600 who are dying each
day.

He gives nine reasons why we should sit back and continue to let
600 people die per day. The last of the great humanitarians it
seems.


 > He is not forgetting how many are dying?

Please indicate to me where in his text did it indicate that
there was even a hint of compassion.


 > but he's arguing for those who need treatment for HIV to be
 > able to access effective treatment into the future; he's argu-
 > ing to try to prevent more people becoming infected with HIV
 > as a result of diversion of prevention resources to pay for
 > antiretroviral drugs; and he's arguing that more people should
 > not die from other preventable and treatable conditions be-
 > cause resources have been diverted from primary health care.

That is why he is a fool. He wants the whole primary health care
system restructured before the ARV roll out. Here he puts his
foot in his mouth. Now if he wants a restructured health deliv-
ery service why does he not trumpet it? Why does this man try to
hold those who are desperate for treatment hostage to his
greater schemes and dreams?

Everyone is good at putting their finger everywhere except on
the right spot. The problem is Mbeki. Nothing else. If he could
find ZAR 60 billion for weapons of war then it shows where the
man's priorities lie and that is certainly not with the health
of the nation. And our Peter Barron is just dancing around the
issue.


 > When countries have an adequately resourced health care service
 > it becomes possible to treat people effectively with antiretro-
 > viral drugs - without it there are dangers for individuals and
 > the community of rapid spread of availability of antiretroviral
 > drugs. This is not a simple argument that people in poor set-
 > tings can't take drugs properly - they are just as motivated as
 > people with HIV anywhere to take life-saving medication - (and
 > it is as difficult for them as for people anywhere to sustain
 > the motivation over many months). But in poor settings people
 > are more likely to suffer interrupted supplies of medicines,
 > unless there are strong drug ordering, storage and supply sys-
 > tems in place. These are needed for malaria medication and for
 > antibiotics for respiratory infections, as well as for antiret-
 > roviral drugs. If they get severe side-effects or treatment
 > fails they need functioning referral networks to be in place.

Yes as you seem to have seen I was not convinced by Peter Bar-
ron's nine good reasons to let people die and you are now trying
to add a few more. It's not working Wendy.

I wish this situation would be treated as an emergency. We have
a number of sites where there is the commitment (and the human
compassion, I must add) and the capacity to serve their direct
communities in the right way. We need to start there and push
the development outwards from there. Does this man really expect
the ARV roll out to be put on hold not only until all the ARV
ducks are neatly in a row but (believe it or not) until all the
nations health care policies and infrastructure are as well. The
mind positively boggles.

South Africa is essentially a corrupt country. There is no doubt
that within days of the roll out starting the drugs will find
their way onto the black market (either sold by those in the
health care system or by relatives of the ill). We need to learn
to live with that. Should we expect the government to do some-
thing about it? Obviously not they have a lot a stake on this
one and a specific interest in the treatment roll out failing.


 > There are dangers from the urgency of the current push to expand
 > access to antiretrovirals. These need to be pointed out so that
 > we can try to avoid them. In pointing them out we are not sug-
 > gesting that the international public health community should
 > not be working towards increasing access to antiretrovirals -
 > but that we need to be careful how we go about it in order to
 > avoid greater numbers of premature deaths, and more misery.

Well there are two ways of doing this. One is the Barron way.
This could be termed the *Prophet of Doom* approach and it in-
volves just listing the negatives and sitting back to watch the
people die. The other altogether more intelligent approach would
be to provide counter measures and actions to these dangers. Too
much to ask?

Wendy, how can there be more misery than there is already?

As to the comment "greater numbers of premature deaths". What
nonsense is this? By the time people qualify to receive these
treatments their passage has already been booked. They are going
to die. How can treating them kill more than are already going
to die?


 > Advocacy has brought the cost of drugs down - but continued ad-
 > vocacy is needed to get sufficient resources allocated (by the
 > US, by multi-nationals, and by national governments) to build
 > the necessary capacity to enable effective management of people
 > with HIV into the future. It is dangerous to pretend that people
 > with HIV can have equitable access to life-saving treatment
 > without governments allocating considerably more resources to
 > the health care sector.

Yep. Cost of drugs is down but still a whole bunch of reasons
why the roll out should be delayed. Why are we always looking
elsewhere for the resources? Cut the corruption, cut the arms
purchases and cut the waste and then we could probably pay for
it all ourselves. What Mbeki is saying to the world is that he
doesn't give a jot about the 600 deaths per day and if anyone
else cares about them then they should get the money from else-
where because he is not going to chip in with a cent... in fact
when the money from outside finally starts arriving then he and
those riding on the great big ANC gravy train will demand their
cut from that as well. The fools and useful idiots accept it all
as business as usual. That is the great tragedy.

--
J Mark Adams
mailto:j.mark.adams@iafrica.com