Saturday, January 21, 2012

Repost: I Really Have to Talk to Bono

I am just about finished White Man’s Burden: Why The West’s Efforts to Aid the Rest Have Done So Much Ill and So Little Good by William Easterly. It has taken me a long time to read this book for two reasons: 1) there is a lot of detailed information and 2) I did not want to believe what he was saying. Easterly writes in a clear manner and provides many notes. He states his sources. I now have yet another list of books I want to look at.
In a chapter called “The Healers: Triumph and Tragedy” Easterly talks about AIDS. I found this to be one of the most depressing chapters. Before reading this chapter, I thought that (Project) Red was a good idea. Now I am not so sure. Bono has constantly made the point that the antiviral drugs needed to help AIDS patients are cheap and available at any chemist’s shop. These drugs cost “$304 per person per year” (p. 250) which sounds good until you add in all the other costs:

Three hundred and four dollars is just the price of the first-line therapy drugs per year. The population first needs to be tested to see who is HIV-positive. Patients need to have their viral load tested to see if they should start taking drugs and, after taking them, if the drugs are working to decrease the viral load. The drugs are toxic with potentially severe side effects. Health workers need to adjust the combination of drugs when side effects are too extreme. Patients need counseling and monitoring to make sure they are taking the medicine (if there is less than full adherence to treatment, the virus builds up resistance to the drugs.) Patients also need treatment for the opportunistic infections that afflict AIDS sufferers. So treatment is more expensive than just the cost of the drugs. The World Health Organization is working with the figure of $1.500 per year per patient for delivering treatment to prolong the life of an AIDS patient by one year. (Page 250)

$1,500 still does not sound like a lot. Multiply that by the 29 million plus (p.239) people currently infected. Then add the new cases everyday. It adds up to a whole whack of cash to keep people alive for one year. What about all the people who will die of other diseases?

According to Easterly, “the total amount of foreign aid for the world’s approximately three billion poor people is only about twenty dollars per person per year.” (p.251) Easterly asks where the money for AIDS treatment will come from.

President Bush’s 2005 budget proposal increased funding for American AIDS program (especially treatment), but cut money for child health and other global health priorities by nearly a hundred million dollars (later reversed after protests.)

Bush’s cut in other health spending was particularly unfortunate when two and a half times as many Africans die from other preventable diseases as die from AIDS. These diseases include measles and other childhood illnesses, respiratory infections, malaria, tuberculosis, diarrhea, and others. Worldwide in 2002 there were 15.6 million deaths from these causes, as opposed to 2.8 million deaths from AIDS. (p.251)

When stated like that it doesn’t make sense to spend so much money on treatment of AIDS when cures and prevention for these other diseases (the cure for tuberculosis costs $10) are available. The money should be spent where it will do the most good. Thanks to people like Bono, AIDS is currently sexy and Western donors are anxious to be seen giving to the right (sexy?) causes. Easterly calls the current push for AIDS treatment SIBD Syndrome (p. 254). SIBD stands for “something is being done.” Rich country voters need to be convinced that SIBD to keep them donating. “A political campaigner giving a graphic description of AIDS patients dying without life-saving drugs is hard to resist…. But money should not be spent according to what the West considers the most dramatic kind of suffering.” (p. 257)

Easterly also makes an argument for prevention of AIDS verses treatment. “A years supply of condoms… costs about fourteen dollars.” (p.251) Treatment is not a cure and the first-line drugs do not work for long.

The United Nations Population Division in 2005… estimated that the added years of life from antiretroviral treatment to be a median of 3.5 years. After that, resistance to the first-line treatment (the one with the cheap drugs, which is all that is on the table in Africa, outside South Africa) builds up and full-blown AIDS sets in. (p. 253)

Can we really justify spending millions of dollars to keep people alive for another four years when others are dying of curable diseases? If you asked the people of Africa, would they want so much money spent on AIDS treatment? Consider this:

If money spent on treatment went instead to effective prevention, between three and seventy-five new HIV infections could be averted for every extra year of life given to an AIDS patient. Spending AIDS money on treatment rather than on prevention makes the AIDS crisis worse, not better…. For the same money spent giving one more year of life to and AIDS patient, you could give 75 to 1,500 years of additional life (say fifteen extra years for each of five to one hundred people) to the rest of the population through AIDS prevention. (p. 255 emphasis his)

Easterly also talks about how AIDS prevention programs have been scuttled by religious groups. These people feel that giving people condoms will lead to promiscuity. Hmmm. I’m not going to go there. All I know is that condoms would help. These people stopping prevention programs in the name of some deity of other are causing a lot of pain.

So all this brings me to my current crisis about Bono, (Product)Red, and The Global Fund. Last week I spent some time reading things on the GF website. I was trying to find out how much of the money goes to AIDS prevention and what kinds of preventions the GF supports. Easterly has a long, very long and hard to read chapter in his book about aid bureaucratic language. I can honestly say I tried to read the reports and papers on the GF site. But I soon got frustrated because they seemed to use a lot of words to say very little. If I had not read Easterly’s book I might not have noticed. I never did find the answer to my question although I did find the statement that the GF was committed to a balance of prevention and treatment. I found descriptions of prevention activities for malaria and TB but nothing for AIDS prevention. The only mention of AIDS prevention was on their main AIDS page: “Components of successful prevention efforts include clear and accurate communication about HIV/AIDS and methods to prevent infection, HIV counseling and testing, and treatment of sexually transmitted infections.” Nothing specific (besides talking to people). So I emailed them and asked for specifics. I’m still waiting for a reply.

Until I get an answer I can’t support The Global Fund. I now know that I cannot support any AIDS aid agency that doesn’t spend the bulk of its money on prevention.

Sorry Bono.

I’ll be posting more about Easterly’s book. One post cannot cover the many important points.

End of part one. See part two next Saturday.

Reposts are posts written for previous journals or other places online that no longer exist.

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