[e-drug] NYTimes: Refusing to Save Africans

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E-drug: NYTimes: Refusing to Save Africans
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[Below is an editorial in the New York Times about Natsios's comments. 
Natsio is the new head of USAID, see 'Dead wrong on AIDS. [Copied from 
Ip-Health. KM]
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June 11, 2001

Refusing to Save Africans
By BOB HERBERT

Giving the back of his hand to the suffering of millions, a key Bush
administration official is opposing any extensive use of the
life-extending anti-AIDS drugs in Africa, insisting that the health care
infrastructure is too primitive and that Africans, in most cases, are
incapable of following the regimen.

As head of the U.S. Agency for International Development, Andrew Natsios
is the administration's point man on foreign aid. In an interview with
The Boston Globe, he said the money raised by a new global fund to fight
AIDS should be used almost entirely for prevention services, not for the
antiretroviral drugs that have been so successful in extending the lives
of people infected with H.I.V.

Painting with a very broad brush, Mr. Natsios said attempting to get the
drugs to Africans any time soon would not be worth the effort because of
the difficulties posed by a lack of roads, shortages of doctors and
hospitals, wars and other problems.

According to Mr. Natsios, the problems extend to the Africans
themselves. Many Africans, he told The Globe, "don't know what Western
time is. You have to take these (AIDS) drugs a certain number of hours
each day, or they don't work. Many people in Africa have never seen a
clock or a watch their entire lives. And if you say, one o'clock in the
afternoon, they do not know what you are talking about. They know
morning, they know noon, they know evening, they know the darkness at
night."

This view of Africans as so ignorant they can't master the concept of
taking their medicine on time has become a touchstone of the Bush
administration. Back in April, The Times's Joseph Kahn reported on
concerns voiced by an unnamed senior Treasury Department official: "He
said Africans lacked a requisite `concept of time,' implying that they
would not benefit from drugs that must be administered on tight time
schedules."

Africans may be dying by the millions from AIDS, but the brutal
stereotyping of the Dark Continent lives on, encouraged by U.S.
government officials who should know better.

Mr. Natsios's primary response to the epidemic that is roaring like a
fireball across southern Africa is to just say no. "Just keep talking
about prevention," he told The Globe. "That is the strategy we're using
- even though I'll be beaten up and get bruises all over me from the
fights on the subject."

Mr. Natsios may not realize it, but just talking about prevention has
failed. In sub-Saharan Africa, more than 25 million people are infected
with H.I.V., and more than 17 million have already died. In South
Africa, which is being brought to its knees by this epidemic, the rate
of infection for all people 15 to 45 years old has nearly reached 20
percent.

The United States, a rich and healthy nation, cannot close its eyes to
suffering on such a colossal scale. There is medication available to
ease the suffering and its cost is coming down. Now the steps must be
taken to get the medicine to the people in need.

I spoke with Mr. Natsios last Thursday. He conceded that in South Africa
and the country with the worst outbreak of AIDS in the world, Botswana,
the health care infrastructure is, in fact, pretty good.

As for the difficulty Africans or anyone else might have following the
daily antiretroviral regimen, now might be a good time to burst a widely
held misconception. Antiretroviral therapy does not always require
patients to take dozens of pills a day.

"Our patients take two pills in the morning and two pills in the
evening. That's it," said Toby Kasper, an official with Doctors Without
Borders, which recently established an antiretroviral therapy program
for patients in a village in South Africa.

The trend in drug therapies - in the U.S. and elsewhere - is toward
newer, more consolidated regimens that are easier to follow.
Mr. Natsios reluctantly acknowledged that some limited use of
antiretroviral treatment in Africa may be O.K., and he said he didn't
mean to offend anyone with his comments about African concepts of time.

The truth is that both prevention and drug therapy are desperately
needed in Africa.

No one believes antiretrovirals can be effectively administered in
countries that are at war, or in areas devoid of doctors and hospitals
or clinics. But there is a role for antiretroviral therapy to play in
the catastrophe in sub-Saharan Africa.

And it would be to the everlasting shame of the United States if its
officials proved to be a barrier to that kind of life-saving treatment.


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