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A broken promise, paid for in lives [Globe and Mail]

As the G8 gathers this week, it leaves a legacy of failure on its biggest pledge: to provide every AIDS patient in Africa with life-saving drugs

Globe & Mail, June 24, 2010

By Geoffrey York

When they are told there’s no medicine, the patients react first with anger and suspicion, and sometimes tears. “We know you have the drugs,” they tell the clinic staff. “Why are you hiding them? Do you want us to die?

It’s an agonizing scene that unfolds daily in the AIDS clinics of Malawi and many other African countries these days. The patients find it hard to believe, but it is true: The medicine is not enough to go around.

“They think we’re lying,” says Gabriel Mateyu, co-ordinator of AIDS treatment at a network of Canadian-supported health centres in Malawi. “They just stand there and look at you. Some of them are almost crying. It’s a blow to them, because they had hope.”

If the G8 had lived up to the promises made in 2005 at the summit in Gleneagles, Scotland, there wouldn’t be stories like this. That promise – to provide every AIDS patient with life-saving medicine – was supposed to have been fulfilled this year. Instead, the G8 gathers this week, attempting to rally around the cause of maternal health, with a legacy of failure on arguably the biggest promise the group has made.

At later summits, that promise was watered down, weakened, and then quietly shelved and abandoned. Now, on the eve of the latest G8 summit, AIDS treatment groups are vowing to hold the G8 accountable for its past pledges. Its broken promises, they say, are threatening the lives of millions of Africans who have the AIDS virus.

“The key issue is whether the G8 will meet its commitment. The consequences of not doing so are profound,” says James Orbinski, co-founder of Dignitas International, a Toronto-based medical humanitarian organization that is providing treatment to thousands of AIDS patients at 22 clinics in southern Malawi.

While a steep rise in AIDS funding in the past decade has allowed four million people to gain access to life-saving anti-retroviral medicine around the world today, there are still a further nine million people – mostly in Africa – who need treatment and cannot get it.

More than $11-billion is needed to bridge this global gap, according to United Nations estimates. But many of the world’s biggest donors are freezing or reducing their funds for AIDS. As a result, there are growing shortages of medicine across Africa, forcing organizations such as Dignitas to ration their medicine and put patients on waiting lists instead of giving them immediate help.

The rationing has dramatically worsened over the past year. In the district of Zomba in southern Malawi, for example, the drug shortages mean that 680 patients were relegated to a waiting list for treatment. A year ago, no patients were on the waiting list. Those on the waiting list have a “significantly reduced” chance of survival, Dignitas says.

Beginning three months ago, the Zomba clinics were forced to cut back the number of new patients who receive anti-retrovirals. Instead of giving treatment to 350 new patients a month, the number has been cut to 250.

Dignitas has been obliged to impose a rationing system, giving priority to pregnant women, children, and patients with the worst illnesses or damage to their immune system. “With each passing day, it will take longer to clear the waiting list … and more people may die unnecessarily while waiting,” Dignitas said in a briefing document.

For clinicians such as Mr. Mateyu, it feels like a return to the 1990s, when Africans routinely died from AIDS because medicine was unavailable. “Instead of going forward, we’re going backwards,” he said.

But there is one crucial difference. Unlike the 1990s, patients today are fully aware that anti-retroviral medicine exists and should be available. So they don’t stoically accept their fate, as they may have done before. When they are told that a clinic cannot give them the life-saving drugs that they need, it feels crueler and more inexplicable. “The pain is worse than before,” Mr. Mateyu said.

He describes how the clinicians must “select a few” – from the many names on the waiting list – to receive medicine. The others are told to come back in a month. “We feel bad about it, but there’s nothing we can do. The patients know they are eligible for medicine. Their immunity is low, and they could get sick any time. They feel they could die any time. It’s difficult for them, and difficult for us.”

Because of the drug shortages, many patients in Malawi are given only a one-month supply of medicine, rather than a normal three-month supply. Many cannot afford the cost of transport to the clinics, so they miss their monthly appointments and their treatment regime is dangerously interrupted.

The inconsistent supply of drugs “can lead to confusion, new side-effects, pill sharing, and an increase in drug resistance and viral load, resulting in the need for more expensive drug regimens and the danger of drug-resistant HIV among the general population,” Dignitas said in its briefing document.

Faced with drug shortages, the patients blame the nurses and clinicians. “We’re seeing people becoming distraught and angry at us, because we’re at the front line,” Dr. Orbinski said. “The anger that’s starting to bubble up is not insignificant. They’re turning against the very people who are trying to help them.”

Malawi is far from the only African country with shortages of anti-retrovirals. A new research report by Médecins Sans Frontières found rising shortages and rationing in countries such as Zimbabwe, Congo, Uganda, and Kenya. Some patients are becoming “treatment refugees” – fleeing across borders to seek medicine in countries such as South Africa, which have bigger budgets, Dr. Orbinski said.

But even in South Africa there are shortages. Sello Mokhalipi, a volunteer who helps HIV-positive patients in the impoverished townships near the city of Bloemfontein, says the unofficial waiting lists are getting worse. “They go to the clinics and they’re told to come back in three weeks,” he says. “How can you tell someone who cannot walk that they should come back in three weeks?”

The drug shortages have arrived at a time when the world’s top scientists are recommending a much wider distribution of anti-retroviral drugs at a much earlier stage in the virus, since early treatment has been proven to save lives. But in many African countries, instead of expanding treatment, the opposite is happening.

“The cutbacks have become so disastrous in places that HIV-positive pregnant women are being turned away, as are people so sick they’re coming to the hospital in wheelbarrows,” said Stephen Lewis, the former UN ambassador for AIDS in Africa, now the co-director of AIDS-Free World.

“Let’s be clear: We’re threatened with another outbreak of death akin to the ghastly pattern of the early years of this decade. It cannot be allowed to happen.”

Dignitas InternationalA broken promise, paid for in lives [Globe and Mail]