The numbers game

It is easy to rail at the Bush administration for the chains in which they tie up their AIDS funding for developing countries — the just-cross-your-legs prevention policies, the our-drugs-or-no-drugs treatment protocols, the abolitionist approach to the sex industry. But you have to give them credit for upping the ante on funding, and for taking treatment for poor people in poor countries out of the realm of dream and into reality.

If Mr. Bush wants to show his compassion by providing life-prolonging therapy to people with advanced HIV infection that’s great. If he wants to trumpet the results of the U.S. President’s (read: Taxpayers’) Emergency Plan for AIDS Relief, which claims so far to have put 1,445,500 people on antiretroviral therapy, grand. But he and his advisers should be aware that this is not just a numbers game.

At a recent meeting in Nairobi, organisations involved in providing treatment reminded US officials that “counting a person who is receiving AIDS drugs is not the same as supporting health for people with HIV… When patients are only provided one part of what we need to survive (however important), the end result is poor health outcomes, questionable accounting practices, and unacceptable loss to follow up.” Put more bluntly, that means that doctors and health services are under pressure to tick the “another patient on ARVs” box as often as possible, regardless of whether they can provide support services to make sure that people stay on these inconvenient, toxic drugs. And they may even fudge the numbers to make it look like they’re reaching more people.

The meeting report (Word doc, 147 kb) also draws attention in particular to the need for treatment for the other common diseases that prey on a weakened immune system. Many of these opportunistic infections can be treated cheaply and effectively, adding years to people’s lives at a fraction of the cost of antiretroviral treatment. But since they don’t add to the chest-thumping “we’ve put x million on ARVs” sucess stories, they are being neglected. (Cynics might add that treatment for some of these other infections also does less for the bottom line of US pharmaceutical companies, although to be fair the President’s Plan has now been bullied into buying some generic drugs).

Racking up numbers of people on life-prolonging therapy is certainly a good thing. But it counts for little if people are dropping off treatment soon afterwards because they don’t get support for sticking to the drugs, or because they’ve died of some other easily treatable but neglected disease.

This post was published on 14/12/07 in Money and AIDS.

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