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HIV/AIDS in Uganda – WSJ article

February 5th, 2010

Aid Watch, a blog I love and read often, posted “How the war on AIDS was lost” in response to a recent Wallstreet Journal article about AIDS treatment shortages and increased HIV incidence in Uganda.  Both articles describe a shortage of AIDS treatment for the increasing HIV infections in sub-Saharan Africa, but then point to spending on treatment rather than prevention as the cause of increasing HIV infections.

I have worked in HIV/AIDS services for almost 5 years and what I know to be true, in the US and Uganda, is that treatment and prevention are interdependent.  I also know that HIV/AIDS is a complex problem with social, economic, political and public health factors – a complex response is essential.  There is not a silver bullet solution to HIV/AIDS.  And prevention is difficult.  The WSJ article praises the Bush administration for PEPFAR, but fails to acknowledge the misguided PEPFAR prevention policies that ignored evidence-based prevention practices in favor of ideology and may have contributed to increased HIV incidence in Uganda and other PEPFAR-funded countries. Finally, the WSJ article failed to mention the innovative and effective work of The AIDS Support Organisation (TASO), an indigenous AIDS service NGO in Uganda.  TASO uses a community-based approach to provide care and services to Ugandans infected and/or affected by HIV/AIDS.

Paul Farmer has spoken out against the treatment vs. prevention debate.  Here he describes the connection between structural violence and HIV, shedding light on the complexities of the HIV/AIDS epidemic and the need for a multi-faceted response (from Pathologies of Power):

HIV attacks the immune system in only one way, but its course and outcome are shaped
by social forces having little to do with actual virus
… From the outset of acute HIV infection to
the end game of recurrent opportunistic infections, disease course is determined by, to cite but a
few obvious factors: (1) whether or not post exposure prophylaxis is available; (2) whether or not
the steady decline in immune function is hastened by concurrent illness or malnutrition;
(3) whether or not multiple HIV infections occur; (4) whether or not TB is prevalent in the
surrounding environment; (5) whether or not prophylaxis for opportunistic infections is reliably
available; and (6) whether or not antiretroviral therapy (ART) is offered to all those needing it.

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