Global Fund Optimistic about AIDS Battle: Growing Caseloads in India, China Cause Concern
Zarocostas, John, The World and I
John Zarocostas is a staff writer for The Washington Times.
Richard G.A. Feachem is executive director of the Global Fund to Fight AIDS, Tuberculosis, and Malaria. He was interviewed recently in Geneva by John Zarocostas and asked about the status of global efforts to stem the spread of the AIDS epidemic.
Question: The World Health Organization's recent report, "Changing History," carried an optimistic tone about the global fight to contain the HIV/AIDS epidemic. Is that a fair assessment?
Answer: It is a fair assessment. There is a mood of optimism in the world today for the first time in the more than two decades of the HIV/AIDS epidemic.
The optimism is based on the fact that the three preconditions for a successful counterattack are now in place. And they are: leadership, affordable and practical technologies, and large amounts of additional finance. We now have sufficient quantities of those three preconditions to feel optimistic about making a big difference in the next five years.
Q: The new study says there will be a lot of attention on treatment, especially antiretroviral treatment, for people in poor countries who now can't afford it. And I understand you hope to reach at least 3 million by the end of 2005. Can you elaborate a bit on this target?
A: Yes, the counterattack against HIV/AIDS is based on prevention--which is extremely important, and we need to do a lot more in the field of prevention. Second, on voluntary counseling and testing, encouraging people to come forward and determine whether they are HIV-positive or negative. And third, treatment and the availability of antiretroviral medicine.
It's the treatment component that's been so weak until now. And the campaign we have begun--the 3 by 5 campaign--is to get 3 million people on antiretroviral therapy by the end of the year 2005, and that will give a big boost to the overall effort.
Q: I suppose a lot of resources will go to sub?Saharan Africa?
A: That's correct. The epicenter of the HIV/AIDS epidemic today is in Africa, and the greatest need for treatment is in Africa. About 60 percent of the Global Fund does go to Africa today, and we don't expect that figure to change.
However, other parts of the world--India, China, Russia, Latin America-- also urgently need to scale up access to treatment. So it's mainly Africa, but it is by no means only Africa.
Q: You are sounding alarm bells about India, in particular, and to an extent, some of the countries in Eastern Europe, the Ukraine, and Russia. What are your concerns about there?
A: These are sometimes called the "new wave" countries of the HIV/AIDS epidemic ... and are of great concern. Epidemics in those countries are running roughly 15 years behind the African epidemic ... but the numbers are climbing very rapidly.
In most of these "new-wave countries," the effort under way today is insufficient to prevent catastrophe.
In countries like India, for example, we need to do a lot more in prevention. We need to do a lot more in voluntary counseling and testing, and we need to establish the infrastructure for treatment, because there will be millions of people seeking treatment in the next 10 years. At the moment, we're simply not ready for that.
Q: For India, current estimates are that it has about 5 million people infected with HIV. Is that correct, and what are the projections?
A: In talking about the HIV epidemic in any country, one has to distinguish between the official statistics and the estimates based on good judgment. We find everywhere that the official statistics tend to underestimate, sometimes grossly underestimate, the true magnitude of the problem.
Looking at official statistics, the current Indian figure is 4.5 million [HIV infections]. But many Indian epidemiologists and public-health experts argue that the true figure is considerably higher . …