[procaare] From Science to Action

[AIDS2002 <procaare@usa.healthnet.org>]

>From Science to Action
AIDS2002 Conference
Barcelona, July 7-12, 2002
****************

This is "the summer before everything is going to change," said Paul Farmer in yesterday's
plenary session. A medical anthropologist, who has spent the past 20 years in Haiti
setting up HIV and TB treatment programmes, Farmer argued that delays and inaction in
providing antiretroviral therapies to the poorest and most needy populations of the world
was no longer defendable.

He outlined a number of expected and unexpected challenges and consequences of introducing
ARVs in resource-poor settings, contending that these challenges can be overcome "We've
learned all these lessons before, we've learned these lessons with TB".

In terms of infrastructure, Farmer argues that we should be asking the question "What is
necessary to get going?" rather than getting hung up on the issue of lack of
infrastructure as a barrier. He drew from experiences of the Haitian experience, where the
poor health infrastructure was a surmountable barrier to the implementation of ARV
treatment.

With the active participation of community health workers, many of whom are HIV positive,
a system of directly observed ARV treatment had been provided to over 2,000 HIV-positive
patients in rural Haiti.

Farmer noted the difficulty the Haitian project had encountered in scaling up as many
donors declined to provide funding on the basis that the project would not be
cost-effective or sustainable. He countered that most cost-effectiveness analyses failed
to take into consideration the rapidly changing costs of ARVs, the cost incurred from the
widening income gulf between rich and poor and the costs of treating over and over
opportunistic infections.

Most importantly, he said, these studies do not take into account ethical considerations.
He highlighted the positive impacts of linking prevention to care, noting a much larger
uptake of VCT services when ARVs became accessible.

Farmer also identified poverty and stigma as challenges, noting that those trying to
combat HIV can't avoid taking on larger issues of social injustice. He highlighted the
capacity of ARV treatment to reduce stigma against people living with HIV/AIDs, citing a
Haitian acquaintance, who before taking the ARV treatment showed visible signs of wasting.
Two months after starting treatment he professes. "Now my children are not ashamed to be
with me in the street anymore."

Starting too late, Farmer remarked, was one of the biggest lessons learnt in the response
to the AIDS epidemic in the past 20 years. "If we are honest, we will conclude that our
own ambivalence regarding HIV therapy for the poorest has hamstrung efforts as much as
anything else. We can use this moment to atone for our collective inattention to a host of
preventable and remediable afflictions."

Key Correspondent
Health & Development Networks
AIDS2002 Conference

Email: correspondents@hdnet.org
Web: http://www.hdnet.org

--
To send a message to ProCAARE, write to: procaare@usa.healthnet.org
To subscribe or unsubscribe, write to: majordomo@usa.healthnet.org
in the body of the message type: subscribe procaare OR unsubscribe procaare
To contact a person, send a message to: procaare-help@usa.healthnet.org
Information and archives: http://www.procaare.org

The views presented in ProCAARE do not necessarily reflect the opinions of
SATELLIFE  (http://www.healthnet.org), the Harvard AIDS Institute
(http://aids.harvard.edu), or Health & Development Networks
(http://www.hdnet.org), unless otherwise stated. The reader assumes all
responsibilities in using information posted or archived by ProCAARE.
Reproduction is welcomed, provided ProCAARE and procaare@usa.healthnet.org
are quoted, and SATELLIFE is informed of usage.