The New York Times > Health > A U.N. Report Takes a Hard Look at Fighting AIDS in Africa
March 5, 2005
A U.N. Report Takes a Hard Look at Fighting AIDS in Africa
By LAWRENCE K. ALTMAN
Billions more dollars will be needed to curb the spread of AIDS in Africa, but as countries increase their donations, the amounts will be less important than how well they are spent and in what context, a new report from the United Nations AIDS program said yesterday.
Pouring more money into programs to combat AIDS could do more harm than good unless they are effectively coordinated, the report, "AIDS in Africa," said.
Otherwise, the report said, major financing increases could serve to drive an "AIDS industry rather than to drive a massively improved response." The report was released at a meeting in Addis Ababa, Ethiopia.
As H.I.V., the AIDS virus, spreads further, Africa will face "an unprecedented crisis and a challenge never before seen since the advent of slavery," Dr. Peter Piot, the executive director of the Geneva-based United Nations AIDS program, said at a news conference in Addis Ababa, according to Reuters.
The United Nations said the report was intended to improve decision-making and deepen public understanding of the possible course of the AIDS epidemic in Africa by 2025, when "no one under the age of 50 in Africa will be able to remember a world without AIDS."
By then, 89 million more people in Africa could be infected with H.I.V., under the worst circumstances, the United Nations said. An estimated 25.4 million people in Africa are infected now.
"The death toll will continue to rise, no matter what is done," the United Nations report said. "There is no single policy prescription that will change the outcome of the epidemic."
The report describes three plausible situations in which the AIDS pandemic could play out across Africa by 2025. The situations were told as stories that were prepared over the last two years and intended to be provocative, not to provide all the solutions.
In one outline, African countries adopt tough long-term measures in which leaders exert the discipline to equate action with rhetoric and focus on prevention. By 2025, the numbers would grow but then fall to today's levels and continue to fall. But the number of orphans would double. This plan would cost an estimated $100 billion with the United States spending $5 billion a year to 2015 and then $6 billion a year.
In a second situation, which would be medically focused, prevention measures would not be stepped up, so anti-retroviral drugs would be easier to obtain than good nutrition and clean water. In this approach, government leaders would fail to get ahead of the AIDS epidemic, and Africa's poverty and underdevelopment would deepen. Keeping such services at today's level would cost $4 billion a year by 2025.
A third outline envisioned investments in health systems, agriculture, education, electrification, water and roads to change fundamentally the ways donors provide aid and recipient countries deal with the donations, to avoid inflation and not promote dependency. Such a situation would provide anti-retroviral drugs to 70 percent of people needing them by 2025.
That effort would be expected to halve the number of people living with H.I.V. and AIDS despite an anticipated growth in population of 50 percent. The cost would be $200 billion, with the United States increasing its contribution to $10 billion a year by 2014 and sustaining that amount until 2025, when it would begin to decrease.
The United Nations prepared the report with support from the African Development Bank, the Bill and Melinda Gates Foundation, Royal Dutch Shell, the World Bank and a number of government agencies and drug companies. The report is available online at www.unaids.org.
Copyright 2005 The New York Times Company
http://www.nytimes.com/2005/03/05/health/05aids.html
A U.N. Report Takes a Hard Look at Fighting AIDS in Africa
By LAWRENCE K. ALTMAN
Billions more dollars will be needed to curb the spread of AIDS in Africa, but as countries increase their donations, the amounts will be less important than how well they are spent and in what context, a new report from the United Nations AIDS program said yesterday.
Pouring more money into programs to combat AIDS could do more harm than good unless they are effectively coordinated, the report, "AIDS in Africa," said.
Otherwise, the report said, major financing increases could serve to drive an "AIDS industry rather than to drive a massively improved response." The report was released at a meeting in Addis Ababa, Ethiopia.
As H.I.V., the AIDS virus, spreads further, Africa will face "an unprecedented crisis and a challenge never before seen since the advent of slavery," Dr. Peter Piot, the executive director of the Geneva-based United Nations AIDS program, said at a news conference in Addis Ababa, according to Reuters.
The United Nations said the report was intended to improve decision-making and deepen public understanding of the possible course of the AIDS epidemic in Africa by 2025, when "no one under the age of 50 in Africa will be able to remember a world without AIDS."
By then, 89 million more people in Africa could be infected with H.I.V., under the worst circumstances, the United Nations said. An estimated 25.4 million people in Africa are infected now.
"The death toll will continue to rise, no matter what is done," the United Nations report said. "There is no single policy prescription that will change the outcome of the epidemic."
The report describes three plausible situations in which the AIDS pandemic could play out across Africa by 2025. The situations were told as stories that were prepared over the last two years and intended to be provocative, not to provide all the solutions.
In one outline, African countries adopt tough long-term measures in which leaders exert the discipline to equate action with rhetoric and focus on prevention. By 2025, the numbers would grow but then fall to today's levels and continue to fall. But the number of orphans would double. This plan would cost an estimated $100 billion with the United States spending $5 billion a year to 2015 and then $6 billion a year.
In a second situation, which would be medically focused, prevention measures would not be stepped up, so anti-retroviral drugs would be easier to obtain than good nutrition and clean water. In this approach, government leaders would fail to get ahead of the AIDS epidemic, and Africa's poverty and underdevelopment would deepen. Keeping such services at today's level would cost $4 billion a year by 2025.
A third outline envisioned investments in health systems, agriculture, education, electrification, water and roads to change fundamentally the ways donors provide aid and recipient countries deal with the donations, to avoid inflation and not promote dependency. Such a situation would provide anti-retroviral drugs to 70 percent of people needing them by 2025.
That effort would be expected to halve the number of people living with H.I.V. and AIDS despite an anticipated growth in population of 50 percent. The cost would be $200 billion, with the United States increasing its contribution to $10 billion a year by 2014 and sustaining that amount until 2025, when it would begin to decrease.
The United Nations prepared the report with support from the African Development Bank, the Bill and Melinda Gates Foundation, Royal Dutch Shell, the World Bank and a number of government agencies and drug companies. The report is available online at www.unaids.org.
Copyright 2005 The New York Times Company
http://www.nytimes.com/2005/03/05/health/05aids.html
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