The ICASA conference in Nigeria: emerging themes
Abstinence is obviously a politically heated topic, considering that the ‘just say no’ approach is predictably favored by the Bush Administration, a major funder of HIV prevention programs in Africa, while the actual effectiveness of abstinence promotion is deeply questioned by the scientific community. It is no small irony that Winnie Madizikela-Mandela should appear at the ICASA conference as a vocal proponent of abstinence, given her personal struggles with abstinence when her husband Nelson was languishing on Robben Island, and her issues with old-fashioned fidelity after his release from prison in 1990. Perhaps in this sense she functions as a living symbol of the conflict between the allure of purity and the reality of human desire, though I doubt that she (or her followers) see things quite this way.
Access to first-line AIDS drugs in Africa is very limited – according to recent WHO figures, less than 10% of AIDS patients in need of anti-retrovirals in Africa are now on treatment. So it is deeply worrying to learn that a percentage of whatever ‘lucky few’ manage to gain access to first-line drugs will need to switch to more expensive second-line regimes, which pharmaceutical companies are not marketing in Africa (because poor people are poor consumers) and for which no generic equivalents are being produced. According to a presentation at ICASA by Doctors without Borders, standard first-line therapy currently costs $194 per year, while second-line treatment costs approximately 8 times as much ($1661).
It is discouraging to realize that new efforts to lower prices for second-line AIDS drugs will have to be launched when the vast majority of AIDS sufferers in Africa still cannot get the first-line treatments, and while AIDS patients in developed nations virtually have universal access to treatment -- first-line, second-line and beyond. There is no way around it: the abiding problems surrounding access to AIDS treatment are unlikely to be overcome without narrowing global inequalities.