Saturday, February 08, 2003

Michael Kelly effusively praises the Bush administration's proposal for a massive AIDS-fighting program for Africa, and calls for even more. "The drugs that are saving the lives of thousands upon thousands of Americans can do the same for millions upon millions of Africans," he writes. "Do more. Up the ante. Make that $15 billion $30 billion. Do it now. Save 10 million lives."

Now I'm no medical expert--and I invite knowledgeable readers to correct me if I'm wrong--but this whole plan sounds to me like a recipe for utter disaster. As I understand it, antiviral medications are somewhat like antibiotics, except that they are much trickier to use effectively, and their targets much harder to kill and much more adept at rapidly developing drug resistance. Flooding underdeveloped countries in Africa and elsewhere with these new anti-AIDS cocktails virtually guarantees that they will be used incompetently, failing to save the patients who take them, but powerfully expediting the evolution of drug-resistant strains of the AIDS virus. And if other potent viruses turn out to be vulnerable to the same or similar drugs, then they, too, may well develop resistance as a result of the drugs' widespread casual use.

All of this would be merely tragic if AIDS were a disease like, say, malaria--that is, one whose spread is extremely difficult to prevent, and against which any medical weapon, however weak and temporary, is still better than hopeless dispair. But AIDS is ridiculously easy to prevent (especially for those of us whose personalities provide a kind of natural resistance to transmission, but for others as well). Before the age of widespread antibiotics, in fact, nobody would ever have thought of treating an epidemic of what was at the time called "venereal disease"--even a fatal one--as a matter of helpless victims being cut down by the thousands or millions. Back then, public health programs that spread the word about the risks of unsafe sex, partner-tracing to notify potentially unaware infectees, and, yes, social stigma kept incurable sexually transmitted diseases more or less under control in Western countries.

These days, of course, attitudes towards STDs have softened considerably, with the result that their spread has been much more poorly contained than in the past. Still, a robust health care infrastructure, including the widespread availability of testing, condoms, STD information and medical guidance, has mitigated the overall deterioration in vigilance, and reduced the danger of antiviral drug misuse. (The high price of the drugs has, in a perverse way, helped as well.)

In countries where such infrastructure is lacking, though, a medication-based capaign against AIDS is not only doomed to costly failure, but may well end up jeopardizing far more lives than it saves, in the long run, by blunting the only weapons available against the disease's onslaught. Certainly, it cannot substitute for the basic hygiene practices that these societies simply must adopt if they are to have any hope of recovering from the crushing medical disaster that has befallen them.

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