E-Mail This Article to a Friend HEALTH CRISIS Invest now to fight AIDS in Africa BY KENNETH H. MAYER, MD

Soon after President Bush returned from Africa last month, his director of national AIDS policy, Dr. Joseph O’Neill, suggested that the United States should not spend more than $2 billion to fight HIV/AIDS in the coming year. He claimed that the health infrastructure in AIDS-burdened African countries expected to benefit from the Bush administration’s AIDS initiative could not support an infusion of the full $3 billion recently authorized by Congress. This assertion not only misrepresents the degree of infrastructure investment required to make widespread AIDS treatment possible in Africa, but also diminishes the urgent need to confront the disease that kills more than 6500 people in Africa each day. The president’s well-intentioned $15 billion AIDS plan deserves an initial $3 billion installment.

As a health-care worker who has come to know many people with HIV/AIDS living in resource-constrained countries, I know how quickly successful treatment can begin. Peter Piot, the executive director of the United Nations AIDS program, said last year, "Treatment is technically feasible in every part of the world.... It is not knowledge that is the barrier, it is political will."

Many health professionals could begin treating people with antiretroviral therapy immediately, but for a lack of affordable AIDS medication. Even in places where trained professionals are few, there is sufficient capacity to scale up treatment for hundreds of thousands of people and to train the next generation of healers very quickly. Treatment is becoming less complex, and the number of pills needed is decreasing.

Congress and the president need to know that considerable capacity to treat AIDS already exists. DOTs (Directly Observed Therapy), a method to monitor medication for tuberculosis patients, is a model for AIDS treatment and is currently available in much of Africa. DOTs has been used successfully to treat AIDS patients in Haiti and other resource-poor settings with only basic laboratory equipment. With proper investment and training, AIDS treatment can be quickly integrated into the existing tuberculosis-control infrastructure.

Needs for the first year of the Bush plan reach far beyond treatment. Many people do not have access to voluntary counseling and testing, adequate nutrition, condoms, or treatment for sexually transmitted infections. The American AIDS initiative should include frontloading funds for training and sensitization workshops for police, prosecutors, judges, and lawmakers on sexual violence against women and women’s rights. It would be a fatal mistake for the administration to allow prevention efforts to be shortchanged in this first year. Immediate investment in the care of those living with HIV/AIDS takes on an added significance now that AIDS treatment in the near future is a real possibility.

The Global Fund to Fight AIDS, Tuberculosis and Malaria, the primary multilateral funding vehicle for HIV/AIDS treatment, has multiple mechanisms to ensure that money it disburses is well spent. The full $3 billion authorized for fiscal year 2004 is needed and can be put to effective use. As the disease tears at the fabric of AIDS-burdened societies, building capacity will only become more difficult the longer the US waits.

Mayer is the medical-research director at Fenway Community Health in Boston, a professor of medicine and community health at Brown University, and an adviser to Health Action AIDS, a project of Physicians for Human Rights.