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Letter: HIV/AIDS is not Africa's only problem - 06/03/2001

Recently I came across a letter in a newspaper article entitled "HIV/AIDS Is Not Our Identity" written by an exasperated African, in which he stated that there was a conspiracy to make it seem like the only thing that came out of Africa was AIDS and that all Africans had AIDS or were about to get AIDS. The writer felt the attention afforded by the international media was too great and was diverting much needed attention from other health problems assailing Africa. Reading this I couldn't but help sympathise to some extent. 10 years ago as part of the fulfillment for my Master Degree in Public Health, I wrote my dissertation on HIV/AIDS. It was entitled "HIV/AIDS and the Health Care System in Uganda". Like the writer of that I too felt that though HIV/AIDS was a big problem, the amount of attention afforded it bordered on hysteria, and was distorting peoples minds. The people in this case being health officials and policy planners. 10 years ago, Uganda was in the grip of an epidemic that seemed set to wipe out the population. At the same time I had the feeling that people only associated Uganda with HIV/AIDS and this was having a detrimental effect on the fight against other health problems. At the end of my thesis I concluded that though HIV/AIDS was a huge problem, " HIV/AIDS should not be treated as a separate health problem, because this will lead to an unequal diversion or distribution of resources in favour of HIV/AIDS programs.."

Support for such an argument comes from figures released by the WHO. At the end of 1999, HIV/AIDS accounted for 20% of all deaths in Africa, which is interesting in and of itself, HIV doesn't actually kills its victims, they eventually succumb to opportunistic infection. Looked at another way, 80% of the deaths in Africa had nothing to do with HIV/AIDS. In actual fact, two thirds of all causes of mortality were due to communicable diseases (which includes HIV/AIDS), but almost half (46%) were due to conditions such as malaria, childhood diseases, measles, diarrhoeal diseases. All these can be treated, or can be prevented by relatively cheap, low cost methods. HIV/AIDS diverts a great deal of resources, as PHA (people living with AIDS) their relatives and extended family, governments and society as a whole struggle to with the pandemic. The appearance of HIV/AIDS has raised an ethical and moral dilemma for health planners. There is no cure, no vaccine available, the drugs that are available for treating the condition are extremely expensive, and are out of reach of all but the wealthiest citizens in African nations. These drugs must be taken for the rest of their lives.

The dilemma for health planners is this; is it right to spend a huge proportion of already scarce resources on a group of people whose lives at best will only be extended for a few years by these drugs, but who will provide an enormous social and financial burden in the meantime? An ethical dilemma to be sure. For the individual PHA, the physician looking after them, their friends and family, the answer is easy - YES! For the health planner, it is much more difficult. To be sure in many countries there are programs being developed to allow PHA's to be more independent and integrating these with Community Outreach program. However these are still in their infancy. There is still the thorny question of HIV/AIDS drugs which is more difficult to answer. Who pays for them? The current controversy where third world nations have decided to break international patents by producing these drugs locally is one answer. But the debate will still rage. Even if they do become available, at$4.00 a dose per person, these drugs are still very expensive in nations where the average health expenditure per person is less than $4.00 per year!

In my opinion it would be wrong to abandon PHA's and people suffering f from AIDS. On the other hand it would be foolhardy and equally wrong to focus on only HIV/AIDS as the main health problem in Africa. As already stated, the vast majority of health problems in Africa are due to preventable causes. HIV/AIDS should not be treated as a separate health problem, but should be integrated into other health programs. Even if we were able to win the battle with HIV/AIDS, that would only be a fifth of the war; we would still have four fifths of the war left to fight, except we would have lost 10 or 15 years.

Dr John Kiwanuka Ssemakula

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