Waiting for antivirals

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.

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Chris has been excoriating Tom Bethell (author of "The Politically Incorrect Guide to Science") over on The Intersection and elsewhere (see, for example, here, here, and several posts here). However, since he's not yet done a takedown on Bethell's chaper on AIDS (titled "African AIDS: a…
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Another approach to reducing HIV transmission is topical microbicides.


A microbicide doesn't need to be 100% effective to be of value, if it only reduced transmission by X%, that is still better than nothing.

Of course the (well recognized) fear is that people will use a microbicide instead of a condom and that will increase transmission, instead of using a microbicide plus a condom.

I think this tells it all:

In 1994 my boyfriend was sent home from the hospital to die. None of the available HIV drugs were working for him. He could not walk or even stand without help. Then a few weeks after he got him the doctor called and said the hospital was doing a clinical test of a new HIV drug, and if asked he was interested. I don't remember what phase it was, but it was the one where they give it to people that are considered beyond hope. His only thought is that it might help others in the future and said yes. Well after a few weeks he started to getting better. After a few months he was doing really well. After a year, you would have never known he as just a few days away from dieing. Now you wouldn't even know he is infected. So, why would anyone think these drugs do not help?

South African nurses are everywhere except for South Africa.

It raises real questions about the ethics of first world countries recruiting healthcare workers from regions of the world where they are paid very low wages

By Chris Noble (not verified) on 26 May 2007 #permalink

In my hospital, Zimbabwean nurses abound. The NHS in the UK is perennially short of nursing cover. Zimbabweans have little reason to stay in a bankrupt country with 3,700% inflation and a megalomaniac dictator in charge, so you cannot really blame nurses for flocking to the UK where they can seek political asylum and/or be employed earning 1000x as much as they would earn in Zim.

The only way to stop the process is a political solution which results in locally-trained medical staff having the confidence and motivation to stay and help develop a decent health service in their own country, not an easy task.

I don't think the ethics of hiring healthcare workers from regions where they are paid low wages are that bad. I think they are actually better than buying consumer products from regions with low wages, buying raw materials from regions with lax environmental controls, buying forest products from regions that are clear cutting old growth forest, buying oil from regions where women are oppressed, buying diamonds from regions where they fund warlords.

If a region can't provide decent wages and a decent life for the people who live there, those people should be allowed to emigrate to someplace that can.

I agree, the answer is a political solution, but that is the last thing that the so-called "leaders" will allow.

I certainly wasn't blaming nurses for working overseas

It just seems that on the one hand western countries are sending large amounts of money to Africa and then on the other hand "poaching" the very healthcare staff that are necessary to use the money effectively.

By Chris Noble (not verified) on 27 May 2007 #permalink

Another fact to remember is that the health care workers from these countries often have HIV themselves, and because of their roles they get exposed to considerable risk of occupational exposure from their patients (through surgery, emergency work, obstetrics&midwifery etc). So the staff become ill and cannot continue to do their jobs either.

It raises real questions about the ethics of first world countries recruiting healthcare workers from regions of the world where they are paid very low wages.
Which question for example?

It just seems that on the one hand western countries are sending large amounts of money to Africa and then on the other hand "poaching" the very healthcare staff that are necessary to use the money effectively.

The Western countries are not "poaching" or hiring. Hospitals and employers are hiring people.