We discussed Aids in our weekly phone-in programme Talking Point. We were joined from the Aids Conference in Durban by South African Minister of Health Mantombazana Tshabalala-Msimang and Stephen Lewis UNAIDS envoy for HIV/Aids in Africa.
With President Bush promising $15bn in aid and pressure mounting on the EU to match that sum, campaigners are hoping that HIV sufferers will soon have proper access to necessary medicines.
Twenty years on from the discovery of the virus, rich countries appear to be committing themselves to providing critical regions such as sub-Saharan Africa with drug funding to bring hope to its four million sufferers.
But campaigners argue that African governments bear as much responsibility in the provision of access to necessary medicines.
The South African government has now raised fresh doubts about a drug that can help prevent new-born babies being infected by their mothers. Is it right to be careful or is it placing lives at risk?
Can developing countries manage the provision of huge quantities of Aids drugs? Is Africa getting a raw deal on Aids drugs?
This debate is now closed. Read a selection of your comments below.
The following comments reflect the balance of views we have received:
I think that the South African leadership should stop serving the interests of pharmaceuticals and follow the example of the rest of the developed world, where there is clear evidence that anti retrovirals do work. Second, more money is needed, far more then what Mr. Bush has offered.
Mohamed Osman, UK
Access to aids drugs is not going to help Africa, instead there needs to be a sense of responsibility especially among African men.
Your commentator just stated that the only way to solve the Aids problem in Africa is with American money, but your commentators implied that America must not put a qualifier on that money. President Bush is correct, in my opinion, in stating that the spending should not only be for medication but also for education. It is sad to see the young dying, but the choices they have made and seem to be continuing to make are causing these deaths. Also, if America is giving the money, America has the right to qualify its use. If that is not acceptable to Africa or to bbcamerica, then perhaps someone else need to be found to supply the funds!
Sue Seibert, USA
Some western countries are to 'blame' for the HIV AIDS situation in Africa. For example here in Canada, the government each year entices hundreds of South African Doctors to come to work and settle in Canada. What is more disturbing is that the government is succeeding in such activities. Canada trains enough doctors but many leave for the US in search of more money. Canada responds to the doctor shortage by stealing doctors from other countries including South Africa which has some of the best medical schools in Africa. In return, the Canadian government throws a few cheap tokens at Africa so it looks like one of good guys.
People with HIV / Aids need to be counselling and should not be discriminated. The people without the Virus should be educated.
A multi-faceted approach to the treatment of an epidemic of this dimension is required. Effective grass roots education (in schools, churches and communities) is necessary in South Africa to help stem the tide of HIV/AIDS. This has been shown to work in countries such as Uganda. Nutritious basic food is necessary for health but there is no scientific evidence to show garlic treats HIV. I worked in rural KwaZulu Natal as a GP for a few years and it is very difficult to get the indigenous population to understand the benefits of taking regular antihypertensives or diabetic medication, let alone a cocktail of Anti-retrovirals.
With President Bush promising $15bn in aid he has actually set the ideas and progress of fighting aids back about ten years by changing the focus from aids prevention to fighting aids with drugs. The only people that will benefit from this change are the drug companies.
Jykio Beyoku, USA
Third World countries deserves help. The thought of millions of people dying monthly from Aids is a nightmare. Rich countries like the USA and UK should provide resources that will prevent this disease from spreading. If they sit by and do nothing, the health of nations is at risk. Not only is money needed, a guaranteed method to make sure the drugs are getting to the people of Africa. Money is not the only way for nations to help; they should send medical staffs to provide medical treatment, as well.
Lawrence Pierce, United States
No amount of money will ever be enough to purchase the the amount of drugs needed to fight HIV in a population. No amount of drugs will be enough for our people who really need them. Where family life and the socio-economic status is way down low, drugs alone can never bring the health and longevity we need to achieve. When I am starved, the drug is toxic and killing. Considering the empty promises, the lip services and the kick-backs there is no salvation. Let's teach our people and use education and prevention our strongest tools to save ourselves
Temesghen Araya ,
It is so much more than the medicine. If people were healthy to start with, if they had access to clean water, food with enough vitamins and minerals to ensure adequate levels of nutrition, if they had access to healthcare, safer sex or contraceptive advice. The medicine would help, but it has been demonstrated time and time again that the healthier the person, the longer they can go without needing the anti-viral medication. Much as I agree with the idea of giving the medicine to these countries, I can't help but feel this is a sop to cover up our basic inability to treat them fairly in the first place.
The $US15million would go a long way to alleviate the AIDS problem in Africa but as long as the continent's leadership and its civil service bureaucrats remain selfish, political and non -transparent the donation will not effectively achieve its goal. There is no reason whatsoever for political bungling or imposition of red tape in a human catastrophe like the one in which Africa is in today.
Simplisio Hove, New Zealand
As a retired Canadian foreign service officer, with many years of service in Africa, I am distressed at the direction the AIDS/HIV debate is taking in Africa. Many leaders continue to blame the Western countries for problems that are largely of their own making and then focus on the cures rather than prevention. All the medicine in the world will not stop this epidemic; prudent behaviour on the part of Africans might.
Herbert Fraser, Canada
Poor countries should have priority in gaining medicines to combat Aids but the price has to be low and not expensive. Preventive measures should also be taking in account through the use of condoms. Nutrition also has to be good enough to enhance the immune system.
Dr Jose Nigrin, Guatemala
Taking ARVs decreases infectivity (thereby helping to prevent new infections), and helps to keep sufferers healthy (so that they can continue to work and feed themselves and their families like other people can). If the SA government is serious about controlling Aids through prevention and nutrition, it should realise this.
Peter Barber, Scotland
The real issue is the cost of Aids-related medicines. SA does not have the ability to fund these medicines. The world does not have the will to do so. As always when there is not an immediately visible financial incentive, no-one is interested in alleviating human suffering.
Michael Adendorff, Australia
Before we condemn the South African government outright, it is important to emphasise that a sizeable portion of officials within WHO are also concerned about elevating HIV/Aids about many of the other killer diseases such as malaria, TB etc, which are equally underfunded and in fact, which account for more deaths than HIV/Aids.
Dr Alex M. Mutebi, Singapore
The Health Minister in her infinite wisdom suggests "eating potatoes, garlic and onions" to reduce infection! When scientific evidence presents a clear evidence of reducing mother-to-child transmission, the government (the President relies on "internet based evidence") decides that distribution of such drugs is not applicable to Africans. Instead she decides to rely on traditional herbs to cure the disease. True, patients have to be healthy enough for the drugs to take effect. But that would be possible if the government spends money on nutrition programmes, rather than buying $300million executive planes for the President.
Jack Higgins, Cape Town, South Africa
Getting the drugs will make a huge difference not only from the medical point of view but the spiritual aspect as well. Imagine being told you are dying and there is so much you have not done yet you know there are drugs available that can prolong your life. Although people know they are not getting cured the fact that they have more time to deal with death, leave things in order for their loved ones and have time to say goodbye is worth it.
Amsale Asrat, Addis Ababa, Ethiopia
Making Aids drugs available to Africans is a crime against humanity. Scientific evidence has proven that Aids drugs are poisonous and dangerous to human beings. Africans need proper nutrition and good education so that they can take care of themselves.
Jika Ntolo, Zimbabwe
Providing therapy will help to slow the epidemic. If there is hope for real treatment many people will have a reason to get tested for the first time. And many of them might then change their sexual behaviour. Access to Aids drugs will save millions of lives over the next years, regardless of some transmission of resistant virus. Multiple ways to distribute drugs need to be explored: via NGOs, community initiatives, or national programs. We have waited much too long.
Henning, St. Louis / USA
Depending on Aids drugs that much will not prevent the spread of Aids. I think education is the key to prevent the widespread of Aids in Africa.
Zenebu, Ethiopia (living in USA)
Paying for Aids medication should be one part of an overall global strategy. Many of the current problems that arise from foreign aid rest with the stipulations placed on it. The recent American commitment (like all others) is designed, in part, to support their own industry while a handout given directly from one state to another will remain unaccountable. An institutional balance needs to be found. No one person created this disease; and as human beings we must share our ideas and knowledge.
Daniel Papineau, Montreal. Canada
There are at least two things that African countries can do to access HIV/AIDS medicines after more than two decades of begging pharmaceutical companies to lift the patents they have over these medicines: either import generic drugs from countries like India, Brazil, and Malaysia, or manufacture the medicines themselves. African countries must understand that HIV/AIDS is an emergency, millions of people are dieing, children are being left without guardians, African economies and security are in peril. Access to medicines must be done with or without permission from pharmaceutical companies!
Story Tali Litowa, Lusaka, Zambia
Coming from the vantage point of someone whose sister is infected with the HIV virus, I hope that what I say does not sound callous. While I more than empathize with the plight of those who are living with HIV in Africa, I think the US focus strictly on treatment is misguided and disingenuous. If the Bush administration is truly committed to a long-term plan to manage AIDS, then why is its focus almost exclusively on the highly lucrative fronts of drugs and treatment rather than on the more politically sensitive fronts of education and prevention?
Sarah, Boston, USA
Africa needs the financial resources to combat the epidemic that is killing up to 30% of some states' populations. However, the money must be used to emphasize prevention and education, in addition to buying drugs. Misconceptions and lies propagated by religious leaders and poorly educated fanatics must be fought as much as the virus itself. With $15 billion dollars, states in Africa should be able to implement culturally sensitive safe-sex education, and promote prevention in their communities, while also providing drugs to as many people as possible. Access to AIDS drugs should be a right like affordable healthcare and education that all human beings are entitled to have.
Meghan Woods, Rhode Island, USA
While prevention education should definitely be used to curb the growth of the AIDS epidemic, it will not do anything to help the millions already infected in Africa. I think it is time the world community realized that it has a compelling interest in providing the medicines, and strip the drug companies of their patents on effective treatments, perhaps still compensating them for R&D. Until medicine stops being driven by corporate greed, no one in developing nations will get the level of medical care that everyone deserves.
Scott Miller, Reseda, CA
The AIDS drugs should be provided by the government of each country and follow the example of Brazil. People living with HIV should be given benefits to help them keep families alive and the economy afloat. Keeping the local average individual healthy and contributing is a goal Eleanor Roosevelt used to promote and this is just as useful today. The economy of the world depends on its lower income people being able to live comfortably. Each president of every country should live for one week in an AIDS hospital.
Ellen, Virginia, US
I agree with Peter K. from Canada (below). Who decided that the western world needed to solve this problem? It's sad that there are so many infected people on the African Continent, but the Western world didn't create the problem. If an American/Canadian/Brit/Etc. contracts HIV, what country is going to send them money for their medication? Sending condoms to Africa would be more effective than sending medication. Prevention is what needs to be stressed or there will be more and more cases of HIV occurring on the African Continent and more people to medicate.
Mike, Charlotte, USA
A comprehensive HIV/AIDS program needs to be developed in which prevention is stressed. However, for those already infected, something also needs to be done, which includes the use of ARVs. No doubt the root of the AIDS pandemic is poverty and a lack of basic needs, so this problem needs to be dealt with hand-in-hand. With my experience of studying abroad in S.A., so many people that are infected are worried about living for the next day, having a meal to eat, a place to sleep, not AIDS drugs or condoms that will save their lives for the longer term. One must also consider that once these people are put on ARV drugs, they will have to remain on the drugs regularly for the rest of their lives. Regardless, something needs to be done and maybe the U.S. should look to Uganda and Brazil as examples of countries that have been successful in curbing the incidence of HIV infection.
Washington, DC USA
Considering the total number of people in Africa who have HIV/Aids and the exorbitant prices pharmaceutical companies force developing countries to pay for Aids drugs, perhaps Africa needs a few drugs "thrown" at it. There are children who face a life alone because parents have Aids, they deserve a chance. But more needs to be done to prevent the problem rather than just treat it. What is the point in treating already afflicted patients if the numbers are just going to keep rising?
AV, London, England
Apparently "we" are responsible for the whole continent of Africa becoming infected with the virus. Apparently "we" should dedicate all our financial resources to stem the spread of Aids in Africa. It appears that "we" are to blame for darned near everything bad that happens in the world, including the sexual proclivities of every male and female on the African continent!! African governments knew about the disease more than twenty years ago and "they" did absolutely nothing. The drugs to combat the disease and the personnel to educate the people of Africa about Aids are available, but because the disease has reached such a high level, nobody is willing to pay for the vast amount of drugs and education needed.
In the successful containment of the recent outbreak of Sars in Asia, perhaps, lies the recipe for success for Aids. Asian nations, led by Singapore, targeted the 'prevention' of the spread of this lethal virus. The efforts, to say the least, were on a war-footing. Scientists & pharmaceutical companies around the world could have invested billions of dollars to find a 'cure' but could not have achieved what Singapore did through containing the virus. I agree with Prof Gallo - only throwing drugs at the affected region is not a solution. More efforts need to be focused on prevention and containment of this virus.
Sanjay Uppal, Singapore
I get nervous any time the West makes large-scale monetary donations to the African Aids crisis. What assurances do we have that corrupt African leaders won't simply siphon the money away as they always do?
Rich, Dallas, TX, USA
Developing countries can deliver Aids programmes efficiently if transparency and accountability is imposed. Keen supervision and scrutiny should be carried out in order to avoid greedy government officials jeopardising funds. Meanwhile, there should be a sensitisation in order to encourage young people to undergo HIV tests in order to combat it in its early stages rather than dealing with full blown Aids.
I agree with Joseph Musembi of Italy as "keen supervision and scrutiny should be carried out in order to avoid greedy government officials", and this supervision should be put in place by the establishment of autonomous international institutions, which are designed for the sole purpose of providing and regulating aid to the poor regions of the world. Currently, the West puts too many stipulations on the little aid it gives. Peer review institutions, like NEPAD, will stop the corruption and force transparency on those governments in search of foreign aid. If developed countries want a seat on the peer review board to 'force accountability', maybe these institutions should allow a very limited annual membership to those with deep enough pockets.
The need here is not only for the infrastructure in terms of medical facilities, but also for an infrastructure spreading the knowledge. Publishing the effects of Aids and methods to prevent it in the language which people can easily understand is important.
Ravi Bhensdadia, Christchurch, New Zealand
I think that Prof Gallo is correct. A country which cannot even manage to feed and educate its people will not be able to properly administer these drugs which will lead to the multi-drug resistant mutations. Also, as there is not a cure for Aids that money would be better spent on initiatives which will really save lives - like eradicating malaria or TB.
Aids spread in developing countries, Africa in particular, is both a result and cause of poverty. This simple understanding is yet to click in the minds of world leaders. As a result more is being done on drug funding and less to address the root cause of Aids spread in Africa: poverty.
It is good that Bush wants to give treatments to Africa. It is too bad that in his own country, many people have little access to Aids medicines that are available at unethically high prices. Bush should start at home first. For a fraction of the cost of his most recent war, Bush could provide medicines to his own people as well as Africa. Bush's priorities are clear. Developing countries I believe can manage the provisions but only with the help of international organisations.
Jeffrey, Cincinnati, USA
Sure, education might help the problem in a way. The only sure fire way is abstinence or faithfulness to a spouse. Look at Uganda.
Ben Haley, US
Abstinence cannot end the spread of Aids. Instead, education, access to simple healthcare and the willingness of the people to talk about Aids comfortably, without shame and guilt may end the spread of Aids.
It is almost certain that abstinence can curb the growth of HIV. Providing HIV drugs not only risks the appearance of immune versions of the virus but also lowers the level of fear amongst sexually active people.
Steven, Paris, France
Did we keep Aids causation and prevention information a secret from Africa for the past 20 years or something? I hate to be harsh, but I'm tired of being held accountable for all of Africa's intractable problems. No matter what outsiders might try to do for Africa, it's like attacking a wildfire with a squirt gun.
Tara, Chattanooga, USA
There is no cure for Aids, therefore won't 'throwing drugs' at the region be keeping people who are already infected with Aids alive longer, and giving them a longer opportunity to infect others? Won't that mean that even more people will end up being infected by Aids?
Louise, Sydney, Australia
We need not $15bn in promises; the disease is killing people now. Kemron was developed by a developing country (Kenya) only to be pushed out before it reached the needy. Condoms and sex education are to help before the $15bn is seen.
Tom J Makori, Moscow, Russia
Thanks to President George W Bush and his government for the grant to fight HIV/Aids. My worry is that some of the beneficiary countries including my own may not make the drugs reach grassroot level because of corruption that has dominated African economies. My suggestion is that the distribution be closely monitored or this programme may end up benefiting the top brass in the beneficiary governments or be diverted to other programmes which may not merit the Aids victims at all.
Namabako Francis, Lugazi, Uganda
I think that this is where nations such as the US could be of more help. I know that in the US great strides have been made in the treatment of Aids. We have access to many options that others do not. Time for us to share what we know with others.
Margaret Engel, USA
The real problem with the Aids virus in the developing world, especially in Africa is that it is devastating the entire generation of people who are already weakened by malnutrition and bad healthcare. More people are killed by tuberculosis which has made a come back due to the HIV. The massive help to treat the pandemic should go hand in hand with poverty eradication and better healthcare system.
Inge Toft, Humlebæk, Denmark
Let us work towards striking a realistic balance between the two issues. A lot of valuable lives needed to develop sub Sahara Africa are at stake and time for academic acrobatics has no place at the moment.
Lemmy V. Luswili, Gaborone, Botswana
In theory, they will have access. However, with the corruption that exists in some of these governments, who is to say that the people will get these drugs, rather than the government selling them? Until the problem of corruption and abuse is dealt with in Africa, all the money and drugs in the world will not help.
The solution to this problem should not be limited to the provision of drugs, but this should include the proper monitoring of the African officials dealing with this task as many are corrupt. Healthcare infrastructure needs to be upgraded.
Wale Olasunmade, Journalist (The Comet),
Brazil developed a very effective strategy to reduce HIV infection rates with condom distribution and awareness campaigns, and to reduce death, hospitalizations, and overall costs with free distribution of generic anti-HIV drugs (and with aggressive drug-cost negotiation with pharmaceutical companies). Why can't other countries do that too?
Max Brenner, Porto Alegre, Brazil
Proper healthcare infrastructure is not a reality that can be created overnight especially in most sub-Saharan countries with impoverished economies and corrupt governments struggling with huge foreign debts among other burdens. In addition there are numerous countries in the region going through crises of war and famine. The fight against Aids should be multi-faceted, yes the provision of ARV, education on prevention as well as programmes on abstinence and the ongoing development of medical facilities.
Mike O' Maera,
Singapore is a developed country but we don't have cheap drugs for our Aids victims. We are the only last developed country which doesn't subsidise Aids drugs. This is a punishment from our government as they still think that HIV and Aids is a "dirty" disease!
Of course developing countries can deliver Aids programs. For example in Cameroon - one of the developing sub-Saharan countries - a lot of doctors and Aids campaign organisations are coming up with development programs in the form of seminars, clubs, open air discussions, just to name a few.
Yes, I think developing countries are already delivering Aids programmes. But the question is if these programmes will be sustainable. The money for accelerating ARV provision is now coming through, and there is no stopping it. A sound Aids programme needs to keep the emphasis on prevention. My worry is that all resources will go to the provision of drugs and prevention programmes will see a decrease in support. There is already a lack of resources to scale up prevention activities.
Gallo is right. The most effective and economic solution would be to fund the distribution of condoms. But this is something the US is loathe to do.
Jon Davis, El Paso, USA
A full and total yes to more condoms, combined with continued education on Aids, but the writer from El Paso seems to forget that millions of people are already infected, and though they still need condoms, they also need treatment, depending on the clinical stage of the disease. The debate on drugs is very important, and we know that indeed health infrastructure is not adequately in place in many developing countries. However, that shouldn't stop us from trying to improve it!
Froeks Kamminga, Accra, Ghana
Having worked in a rural hospital in northern KwaZulu Natal, the rural hospitals are making huge inroads in the treatment of TB. The province has also been extremely successful in the reduction of malaria. Additional funding would be required to employ local people to assist with the distribution of any Aids drugs to ensure that the rural community take their medication on time. It would work extremely well in some areas where the infrastructure is in place but I have serious doubts whether it would work in other countries where the health structures are seriously lacking.
Gail, South Africa
Healthcare infrastructure should be improved first but if they do not have access to basic necessities then how will they be able to make it better? I think rich can countries can also play vital roles but only if they work more sensibly and stop indulging in wars as we are seeing recently.
Tahir Parvaiz, Islamabad, Pakistan
Many people affected by HIV/Aids living in Africa, and who have had access to the Aids drugs have been using them improperly, most often in excess. The latter causes resistant mutants. If there were adequate health care infrastructures in place such cases could be rare. The health care infrastructures definitely should be improved prior to providing these countries with immense quantities of Aids drugs.
Iwona Sawicki, San Jose, USA
Any country, given the will and determination can deliver progress on reducing Aids. However they need to fight ignorance about contraception, often due to long held ritual and religious reasons. They also need to fight poverty and war which leads women into prostitution and finally they need to modernise government, so that the will is there to help the people of the region, as opposed to the current setup where the majority of sub-Saharan countries are led by "tinpot" dictators and where policy is driven by military juntas.
Scott, London, ex-Zimbabwe
Yes developing countries can handle the situation but first of all we need intensive quality education to eradicate polygamy and ignorance which are both helping spread the disease.
F K Bondinuba, Kumasi, Ghana
With all due respect to Dr Robert Gallo for his credibility and accomplishments in the Aids campaign and research, it's fair to acknowledge that Africa faces critical test and challenge in handling a $15 billion medical-aid package. But, sounding a death knell is not the solution to a
continent that is just crying out for help and has been virtually ignored. Now, help is promised. Doing nothing would be worse, devastating and regrettable.
I think this is a real concern. The recent news shows that even highly developed countries have high rates drug resistant strains. It seems more important to reduce the rate of new cases before giving out drugs.
Joe, NY, USA
Yes we can handle Aids drugs. I do understand the concerns of Dr Gallo but a country shouldn't have to choose between a better health infrastructure, which would take years to implement in most African countries, and the immediate delivery of the much needed ARV drugs. Instead of the lengthy infrastructure building, why not try to improve understanding of these drugs by medical personnel. Also, if prevention, care and treatment programs were firmly part of a country's policy, one would hope drug resistant HIV strains wouldn't be a concern.
Banchi, Addis Ababa, Ethiopia
I think the UN or the Red Cross could handle this despite Dr Gallo's lack of faith. Has Dr Gallo heard of safe sex? That would prevent creating new strains and "multi-drug resistant mutants." His references seem odd for a man of his stature. I guess he doesn't believe some people are educated enough to handle the responsibility of participating in their own healthcare. I take offence at the suggestion that "throwing drugs" at the region is a recipe for disaster.
Mr Sandy Clark, San Francisco, USA