AIDS: The Plague the World would rather Forget…

By Dr David KL Quek

 

"Our lives begin to end the day we become silent about things that matter."

Martin Luther King, Jr.

"The victims don’t cry out. Doctors and obituaries do not give the killer its name. Families recoil in shame. Leaders shirk responsibility. The stubborn silence heralds victory for the disease: denial cannot keep the virus away."

Johanna McGeary, in Time magazine, 2001, February 19, p 45.

17 million dead and counting… In hard hitting yet heart tugging poignant exposes entitled "Crimes against Humanity", and "Death Stalks a Continent", Time magazine recently highlighted the overwhelming anguish and the demoralizing despair that has swept the worst afflicted African continent.

One sad fact that stands out is that this plague has never gotten the due attention and the full-bore response of the developed world vis-Ó-vis its deadly reputation. Sporadic and half-hearted measures only lend their off-and-on spotlights, which barely illuminate the surface of the underlying horror that remains largely obscured. They also mask and overplay what limited yet less-than-drastic actions that have been taken thus far. Clearly much more needs to be done, and done fast.

The grim and gristly statistics are starkly evident that all is not well in our meager and totally inadequate response to contain this pandemic. Among the worst-hit are 7 sub-Saharan nations—Botswana, Swaziland, Lesotho, Zimbabwe, Zambia, Namibia and South Africa—which bear the brunt of this incalculable plague which has already afflicted from 20 to 36% of the population. One in five to one in three people in these countries are HIV-infected.

Time magazine has also initiated an internet-based AIDS-clock to highlight the shocking increase in AIDS incidence, one new victim every 25 seconds! This clock is now ticking way past 25 million in the African continent alone.

Entire families have been decimated, and surviving orphans themselves are dying slowly from the disease. Many are isolated, shunned and ostracized by societies and families, which still refuse to accept the sweeping dreadfulness of the HIV reality. Some African national leaders even question the HIV model of the plague, preferring to believe that some other cause brought about by foreign powers are to blame. Such denial is perhaps the worst enemy in the fight to contain or eradicate this mushrooming plague.

Heart-rending stories of such repudiation by families and society have made afflicted victims less ready to face up to the truth and demand treatment or redress. They fear being despised, of being isolated, cursed, rejected, of being blamed for their supposed immorality. Thus the silence and the ignorance grow to envelope the unspoken stench of affliction. Doctors too play their empathetic role by under-recording the diagnosis of HIV-AIDS to spare the victims, their unjust stigma. Many of course did die of the secondary infections brought on by a severely weakened immune status.

Because of the stigma involved and the social pressures to keep the ailment hidden, denial and head-in-the-sand disavowal remain the commonest mode of coping with the AIDS epidemic. This phenomenon is not just true of Africa but is also the usual response worldwide especially among Asian countries. Malaysia is undeniably also guilty of underestimating the scope of the problem, which is in reality far worse than is widely acknowledged.

Therefore while much remains to be done in Africa, the rest of the world has got little to cheer about. The pandemic is not sparing anyone, and Asia is not too far off in the numbers game for AIDS. Without a doubt, the developing world is faring the worst, and will continue to do badly.

This is due largely to the lackadaisical attitude with regards the infectivity and a warped sense of invincibility with regards the HIV infection. Many Asian men continue to engage and indulge in unprotected and promiscuous sex, regardless of the much publicized and staggeringly high HIV infection rate among sex workers in the seedy boudoirs of Asia. The sex trade and intravenous drug use are still the predominant modes of spread for the HIV.

Relentlessly, this problem continues to compound and escalate, and AIDS could potentially wipe out our productive populace. Many who are already infected will die, and die they will, soon. This is because many are totally ignorant and couldn’t care less, until it is too late. Then there are those who cannot afford the new and moderately effective combination anti-viral therapeutic regimens, which per capita, run into the thousands of dollars for a year’s supply. Hence the death rate has not changed much in the third world when compared with the richer nations. There some half the victims are now being kept alive—being sustained because of the ability to curb the viral load.

The financial burden of managing the HIV-infected patients in any country poses a tremendous strain on most governments or healthcare authorities, whether in the private or public sector. Faced with this dilemma of financial incapacity, there have been loud rumblings that multinational pharmaceutical companies, which manufacture such anti-viral agents, should not engage in exorbitant profit making at the expense of the dying masses.

Many poorer nations are seeking ways to bypass such unfair patent laws, which seemingly guarantee high monopolistic prices and controls for the grasping avarice of the huge pharmaceutical companies. Ostensibly this unconscionable practice can only be construed as unacceptable, antisocial and immoral, and should be challenged.

Cipla, an Indian pharmaceutical company has recently proposed a unique scheme, by offering to produce such patented drugs at a fraction of the price, and supply these to the needy and poorer countries especially in Africa. In order to do this, Cipla has stated that it can only reimburse much watered-down royalty payments to the patent-holding companies. Not surprisingly, this offer has been spurned as unacceptable by most of the pharmaceutical giants.

Regardless of this objection, South Africa has opted to go ahead with legislation to allow for the copying and manufacturing of such anti-HIV drugs, as an emergency measure to provide for more effective medical treatment regimens for their HIV cases which has ballooned to more than 4 million! Notwithstanding the legalities involved, drastic situations demand drastic measures.

In another laudable move, another (earlier much-criticized) pharmaceutical giant, Merck has also recently announced that it will sell its anti-HIV drugs to poor countries at a huge discount (90%), to alleviate their plight. They are donating some US $250 million to match the offer earlier given by the William and Melinda Gates Foundation.

Will this be enough? Is it too little too late? Perhaps, but it is a refreshing beginning, that some measures are at last being addressed with a renewed and more tangible vigour. We certainly need more attention, more positive action and more proactive measures in this sad and tragic melodrama of death and suffering. It is certainly about time!

It would appear that sometimes, society including these leading healthcare behemoths does need some prodding to conscientize their social roles. In this time and age, capital gains and bottom-line profits cannot and should not be the be-all and end-all in this lethal game of globalized power and one-upmanship. Healthcare and medicine must also serve not just the industry, but most importantly they must ensure that the receivers or consumers—the patients—are whom we must serve and protect as an unchallenged priority.

For the individual amongst us, what can we do? Not much, but we can exert some influence and voice to add to the mounting chorus of moral indignation to waken the slumbering conscience of the world.

We can repeatedly remind our quickly forgetful citizens that the HIV spectre is still out there ready to inflict its deadly bite and to caution against the spreading complacency and denial.

We should speak out loudly, and do so till we are hoarse. Perhaps then and only then, can we garner sufficient momentum and humanitarian support to wage this stupendous war against mankind’s worst and most unspeakable nightmare.

February 2001

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