Washington 'Dead Wrong' on AIDS
 By Amir Attaran, Kenneth A. Freedberg And Martin Hirsch of the Washington Whore Post
Andrew Natsios, the Bush administration's new chief of the U.S. Agency for International Development
(USAID), has made a very bad start with regard to one of his agency's primary missions: dealing with the
scourge of AIDS in Africa. Natsios has made comments recently on the prevention and treatment of the
disease in Africa that are, to say the least, disturbing, if not alarming.

His comments appeared last week in the Boston Globe and in testimony before the House International
Relations Committee. On both occasions he argued strenuously against giving antiretroviral drug treatment
(the AIDS treatment used in the United States today) to the 25 million Africans infected with HIV.
Although Natsios agrees that AIDS is "decimating entire societies," when it comes to treating Africans, he
says that USAID just "cannot get it done." As Natsios sees it, the problem lies not with his agency but with
African AIDS patients themselves, who "don't know what Western time is" and thus cannot take antiretroviral
drugs on the proper schedule. Ask Africans to take their drugs at a certain time of day, said Natsios,
and they "do not know what you are talking about."

In short, he argues that there is not a great deal the agency he leads can do to help HIV-positive Africans.
Under his guidance, USAID will not offer antiretroviral treatment but will emphasize "abstinence,
faithfulness and the use of condoms" as the essence of HIV prevention. (He also supports distribution of a
drug that blocks transmission of the disease from mother to child, and drugs to fight secondary infections.)

While this might save some of those not yet infected with the virus, it in effect would condemn 25 million
people to death, and their children to orphanhood.
As the administration's man in charge of international assistance, including helping Africans with AIDS, Natsios
should know better. His views on AIDS are incorrect and fly in the face of years of detailed clinical experience.

Take the issue of whether AIDS should be dealt with by prevention or treatment. In backing prevention to
the total exclusion of treatment, Natsios favors only modest changes in the strategies that USAID has relied
on for the past 15 years, which by themselves have clearly failed to stem the pandemic. This is why expert
consensus now agrees that prevention and treatment are inseparable -- or, in the authoritative words of the
UNAIDS expert committee, "their effectiveness is immeasurably increased when they are used together."

The same conclusion has been reached by countless other experts, including 140 Harvard faculty members
who recently published a blueprint of how antiretroviral treatment could be accomplished. Harvard
physicians are now treating patients in Haiti, and others are achieving similar treatment successes in Cote
d'Ivoire, Senegal and Uganda.

It is also disturbing that Natsios chooses to exaggerate the difficulties of AIDS treatment, as if to
single-handedly prove it would be impossible throughout Africa. Whether Africans can tell "Western time" or
not is irrelevant; nearly all antiretroviral drugs are taken only twice a day -- morning and evening. Sunrise
and sunset are just as good as a watch in these circumstances. Nor is Natsios correct when he says the
drugs have to be "kept frozen and all that." Not a single antiretroviral drug on the market today needs freezing.
In fact, some bear warnings not to freeze them.

Natsios also said that "the problem with [delivering] antiretrovirals . . . is that there are no roads, or the
roads are so poor." In fact, millions of AIDS patients live in cities such as Cape Town, Dakar or Lagos, where
the streets are teeming with cars.

Natsios says that antiretroviral drugs are "extremely toxic," so that as many as "forty percent of people . . .
who are HIV positive do not take the drugs . . . because they get so sick from the drugs that they cannot
survive." This is a view shared by no one in the medical establishment today. Clinical and epidemiological
studies by the Centers for Disease Control and the National Institutes of Health have shown that these
drugs are safe for most people and prolong life by many years.

Two facts are clear.

The first is that, in Abidjan and Johannesburg, as in Manhattan, AIDS prevention and treatment must go hand
in hand. And we can accomplish this if the Bush administration contributes adequately to an international
trust fund for that purpose (it has so far promised only $200 million, or just 72 cents per American).
The second fact is that Andrew Natsios, by virtue of his unwillingness to acknowledge the first fact and his
willingness to distort the true situation in Africa before Congress, is unfit to lead USAID and should resign.

Source: Washington Whore Post

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