New research shows that treating HIV/AIDS patients need not be as expensive as feared. But that must not be allowed to fuel complacency about the disease; rather it should encourage more grass-roots engagement.
There was both bad and good news last week for delegates preparing to leave home for this week's International AIDS Conference in Bangkok. The bad news took the form of yet another warning of the potential threat of the disease to developing countries, and of the dangers of complacency and an inadequate political response. This time the warning came from the World Bank, and focused in particular in the situation in India and other South Asian nations, where, according the bank, the situation could potentially become as socially and economically disastrous as it already is in Southern Africa.
The good news came from two papers in the scientific literature, both indicating that the costs of treating AIDS patients need not be as high as widely feared. One, from a group of researchers at the Harvard School of Public Health, has found that the onset of full-blown AIDS can be significantly delayed in those infected with HIV merely by taking regular vitamin tablets (see Low-cost multivitamins 'delay onset of AIDS'). A study carried out in Tanzania revealed that such a course of treatment not only substantially increases a patient's quality of life, but also postpones the need for treatment with expensive retroviral drugs.
The second study also looked at an issue with a strong impact on the costs of treatment, namely the effectiveness of relatively simple combinations of the active ingredients of drugs used to treat HIV/AIDS patients. The short answer is that such generic combinations appear to be just as good (see Generic HIV/AIDS therapy is 'safe and effective'). This conclusion is based on a study carried out by French researchers in the Cameroon, in West Africa, into a pill produced by the Indian company Cipla that combines three such ingredients, namely nevirapin, stavudin, and lamivudine. Their conclusion was that the combination pill was at least as effective as highly active (and expensive) antiretroviral therapy used in industrialised countries.
Boost to treatment efforts
The results of both studies will come as particularly welcome news to those working in the field. The high cost of standard antiretroviral drugs — even at the substantially reduced prices that most major pharmaceutical companies have offered to developing countries — has been commonly seen as a major impediment to the introduction of widespread treatment campaigns. Indeed, it is widely believed that the earlier foot-dragging in South Africa over a commitment to providing such drugs to HIV/AIDS patients was rooted as much in straight economics involved in providing treatment (particularly the potential costs to the country's medical insurance industry) as in president Thabo Mbeki's misguided view that there was no direct causal link between the virus and the disease.
Furthermore, the multivitamin study in particular will give hope to those who maintain that there are many ways of treating sufferers from HIV/AIDS that do not necessarily depend on the fruits of Western high-tech medicine. Any claim that a traditional medicine is successful in curing the disease should be treated with the utmost scepticism; no such claims have been validated scientifically (or even, given the known complexity of the disease, carry a veneer of scientific plausibility). Furthermore the motives of those who make them are often suspect. But alleviating the symptoms — and even delaying the onset of full-blown AIDS — is another matter. And here, such claims should not be dismissed so lightly, and could easily prove genuine.
What both of the new studies confirm, however, is that successfully addressing HIV/AIDS requires a dedicated treatment regime. And that this, itself, means full-blooded support from the top of government down to the individuals and organisations in the front-line. This is where the World Bank detects a potential problem in India.
Its report points out that India has much to be proud of in its response so far; for example, in some of the achievements of its successive National AIDS Control Projects. At the same time, the World Bank report emphasises — correctly — that there are specific problems created by the fact that in many countries in South Asia, infection is greatest among those engaged in high-risk behaviour, such as drug taking and commercial sex; in Mumbai (Bombay) for example, infection among sex workers is about 55 per cent, compared to 0.8 per cent in the general population.
Given the social attitudes towards those who engage in such behaviour, the message getting down to the grass roots is often a confused, if not hostile, one. And this in turn can lead to policies and actions based on either ignorance or prejudice. In either case, the result is that the spread of the disease will only get worse.
Such topics are likely to be high on the agenda of many of those attending the conference that opens in Bangkok later this week. The theme of the meeting is "access for all". The organisers hope that it will be an opportunity to promote the idea that the disease can only be tackled successfully through a top-to-bottom engagement of medical services and those responsible for delivering them. It will hear of the positive results in countries such as Brazil and Uganda who have managed to develop such an approach. And it is likely to highlight other countries — particularly in Asia — where such a strategy remains to be put fully into effect.
Science and health communicators, as we have said frequently in the past, have a vital role to play in this process. Both journalists and those involved in non-governmental organisations are an important source of the authoritative information that is essential if ignorance about the disease, and the social stigma such ignorance can fuel, are to be successfully challenged. But they also form a vital link between those making policy, and those responsible for putting it into practice.
Need for feedback
Furthermore it is important to remember that this process works two ways. The one that fits easiest with many political systems, particularly those (such as in China) that are highly centralised and dependent on top-down planning, tends to focus on spreading official messages about the disease. This can cover public announcements, newspaper coverage, and schools curricula (see Beijing schoolchildren face compulsory AIDS education).
Well thought-out campaigns of this nature are obviously essential, a message that has been frequently repeated by scientists and medical professionals at successive international AIDS conferences since they started in the 1980s. But equally essential communication takes place in the other direction as well. Those engaged in combating the disease on the ground must be able to inform government policy-makers of their experiences, and the challenges that they face. A lack of awareness of such experiences and challenges at the top will only result in ineffective policies that fail to address the full range of issues needed to ensure successful treatment.
Enhancing the skills of science and health communicators in using the Internet to achieve this two-way communication has been one of the main themes of two practical workshops that SciDev.Net organised jointly last year with the United Nations Educational, Scientific and Cultural Organisation (UNESCO) in Kampala (Uganda) and Chennai (India). This week sees the third such workshop, which is being held at the Asian Institute of Technology in Bangkok, and brings together journalists from the whole of South East Asia.
As with the previous workshops, the main aim will be to promote accurate and effective ways of informing communities about the scientific basis of both the disease itself, and potential therapies (particularly microbicides and vaccines) currently being explored. Indeed, both of these topics are the theme of two new 'spotlights' that appear on this website this week (vaccines, microbicides), each seeking to provide a brief overview of the topic and its importance by linking to key scientific articles, news items, reports and websites.
But however vital good science communication is, we do not pretend that it will, in itself, solve any problems (any more that compulsory classes in schools is likely to have a major impact on the habits of drug users). Neither will evidence that relative cheap, effective treatments are available.
The main message that needs to be communicated, particularly in Asia, is that coping successfully with the HIV/AIDS epidemic requires a mixture of compassion, commitment and transparency at all levels of society. If the Bangkok conference can get that message across — along with the sense of urgency that the World Bank says is still missing in countries such as India — it will have taken a step towards stemming what promises to be the biggest single problem to face Asia in the 21st century.