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Commentary

AIDS: The Strategy Is Wrong
Richard Holbrooke, Washington Post, 11-29-05

Holbrooke, formerly U.S. ambassador to the U.N., argues that the last several years of global AIDS policy have been, while well-meaning, wrong-headed.

The huge, and very expensive, international effort has saved the lives of a growing number of people. I have seen some of the beneficiaries of these efforts firsthand in places as remote as rural eastern Uganda -- and it is inspiring. The international assistance effort must be continued, indeed increased.
But as [Jim Yong Kim, director of the HIV-AIDS Department of the WHO] acknowledges, "fewer than one in five people at risk of HIV infection has any access to HIV prevention information," and this must be addressed with larger internationally supported programs. (But remember, once a person is on the drugs, it's for life; to stop taking them is to be hit with a mutant of the original virus.) Until a vaccine is found -- and that is probably more than a decade away -- we must focus on prevention and treatment. Providing treatment is essential, of course, but it is also a bottomless pit as long as the disease continues to spread so fast.
As a strategy, losing more slowly is simply a recipe for an ever-more-expensive, disastrous and deadly failure, which will require more anti-AIDS drugs at ever-greater cost -- a modern version of the old story of the boy with his finger in the dike. Moreover, as Kim points out, current policies require "building and strengthening health care systems in the developing world." This is an essential long-term task with or without the AIDS crisis, but one so daunting that linking it so closely to stopping the spread of AIDS only compounds the odds against reaching either goal.
Only effective prevention strategies can stop the spread of AIDS. Yet it is precisely here that current policies have failed most seriously.

The problem Holbrooke identifies is rooted in the fact that international AIDS efforts are being driven more by passion than rational analysis. Prevention and testing should form the bulwark of anti-AIDS efforts, with targeted ARV treatments used where they can be most effective. By trying to stop the disease in its tracks with drugs we are only diluting our scarce resources while the disease gains momentum.



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