Aetiology

A long time ago, in a galaxy far far away, I reviewed the HIV/AIDS chapter in Tom Bethell's book, "The Politically Incorrect Guide to Science." I discussed his characterization of AIDS in Africa:

As the chapter title suggests, Bethell claims that AIDS in Africa is a made-up epidemic; AIDS is really due to simple malnutrition and dirty water supplies, rather than a virus. Government officials, scientists, and journalists are either too brainwashed or too scared to speak against the "AIDS orthodoxy." The evil liberals aren't concerned about AIDS because the real concern of the left, according to Bethell, is overpopulation in Africa (and hence the emphasis on condom use to prevent AIDS). Public health officials aren't actually concerned about disease in Africa--just overpopulation.

Others suggest AIDS is due directly to use of antiretroviral drugs--that it's the treatment, not the virus, that causes the immunodeficiency that characterizes AIDS. However, a new story, people in Africa are dying because they're not getting drugs, not because of excess use of them. I know--not exactly a headline, right? What makes this different, however, is just why HIV+ patients aren't getting the drugs, according to a Medecins Sans Frontieres report (downloadable here). More after the jump.

Many of you are probably aware that many U.S. hospitals are understaffed when it comes to nurses. On average, according to the article, the U.S. has about 901 nurses and 247 doctors per 100,000 people here--and many of you still probably experience waits at the hospital, even at the emergency room. Imagine, now, 393 nurses and 74 doctors per 100,000 people--that's South Africa's rate. Or 2 doctors and 56 nurses for the same population--like they have in Malawi. There simply aren't enough workers to provide diagnosis and treatment, regardless of the availability of the drugs.

Southern Africa is hardest hit by the AIDS epidemic, accounting for the vast majority of the 40 million infections and the daily death toll of 8,000. Despite the advances in AIDS treatment taken for granted in rich countries, more than 70 percent of Africans who need it are still waiting.

On an average day, about 200 AIDS patients flock to the clinic set up by Doctors Without Borders in Khayelitsha. Many others languish at home, not for lack of drugs but because there aren't enough health workers to administer them.

Mpumelelo Mantangana, a nurse at the clinic, says her workload has soared as other nursing staff have left for better-paid jobs in the private sector or abroad. She understands why -- the work is exhausting and the pay is peanuts.

They suggest a way to get around this shortage, somewhat, but it's a trade-off: shift tasks. Let nurses do some of the work normally assigned to doctors, assistants some work nurses usually do, and have others volunteer to do some additional tasks. However, the problem is that this may also compromise health, as less trained individuals are taking on more critical jobs, including diagnosis and treatment.

How has this happened, when there have been so many world-wide AIDS initiatives?

The report also pointed the finger at donor countries, which pay for antiretroviral drugs and new clinics but don't provide for health workers' salaries to operate them.

It said the U.S. Millennium Challenge Account has committed an $140 million to improve physical infrastructure at health facilities. But no plans have been made to recruit the 600 additional health care workers needed to staff the facilities.

"People living with HIV/AIDS do not only need drugs and clinics; they need trained, motivated health care workers to diagnose, monitor and treat them," the report said.