Winter 05

The Pandemic Puzzle

HIV/AIDS leaders convene to discuss lessons learned and the way forward to deal with the global disease.

Nearly 30 million people around the globe have died in the twenty-two years since AIDS was given its name – and by the time most readers reach the end of the third paragraph of this story, five more people will have succumbed to the disease.

Virtually no corner of the world has escaped; 40 million people are said to be living with HIV/AIDS today. The scourge has been particularly hurtful in small, poor countries, where helter-skelter bureaucracies and weak infrastructures often stymie the most basic relief efforts.

These and other issues came into focus at a special conference convened by the IU School of Medicine late last fall, which brought together some of the world’s leading experts from organizations such as the World Bank, United Nations and World Health Organization to participate in the HIV/AIDS Care in the Developing World: Lessons Learned and the Way Forward. While their topic was global, Africa – a multi-nation continent blighted not only by the disease but by social, political and economic maladies – was the focus of most discussion.

U.S. funding to fight AIDS has increased in recent years. The government committed $15 billion to international relief efforts and programs; in July 2003, President George Bush appointed Randall Tobias as ambassador and U.S. global AIDS coordinator. Tobias said the world’s responsibility in combating AIDS, “to put it bluntly – has not been enough.” But there have been success stories.

“There are many organizations who are engaged in this fight around the world, but I don’t know of any that is doing a better job than the IU School of Medicine,” said Tobias, former CEO of the Indianapolis-based pharmaceutical firm Eli Lilly and Company.

Tobias was referring to the School’s partnership with Moi University in Kenya. Last year the partnership received $15 million from the President’s Emergency Plan for AIDS Relief, which allows the IU and Moi physicians to boost the number of HIV patients they treat from 2,000 to 30,000. To do this, they are building treatment and prevention programs in six rural Kenyan communities.

“AIDS in Africa is overwhelming,” said Joseph Mamlin, MD, co-founder of the partnership who returned to Indianapolis for the conference. “We can’t do it all, but we will handle a significant number of patients in Kenya.” Still, he added, doctors in Kenya often cannot treat patients because of the difficulty of obtaining drugs.

But the AIDS crisis in Africa is not confined to the sub-Saharan region, nor do the statistics paint the full picture of the disease. James Morris, executive director of the UN World Food Programme, said that for every person who has HIV or AIDS, countless spouses, children, parents, neighbors and even local authorities in African countries are affected.

“The lives of women and children are hit the hardest,” said Morris. “In many places, if a husband dies, the wife is left destitute – without a home or food to feed her children.”

Supply meeting demand does not always guarantee success. The internal bureaucracies and unique regulations of nations and relief organizations often are stumbling blocks, noted Debrework Zewdie, PhD, director of The World Bank’s Global HIV/AIDS Program. She cited Ethiopia, for instance, which was designated to receive more than $60 million in assistance since 2001 but where only a fourth of that amount actually has been spent.

The idea for the international conference was spawned last summer when IUSM Dean D. Craig Brater, MD, visited Kenya to get a first-hand look at how the IU-Moi partnership, particularly the HIV/AIDS program, was working. The dean was so moved by what he witnessed that he felt compelled to organize an international gathering to discuss what’s been done and the challenges looming in the worldwide response to AIDS.

As Dr. Brater noted at the conference’s conclusion, perhaps the greatest enemy of the war on AIDS is the one no drug can treat or cure. During his visit to Africa he met a patient named Irene who asked what she and others with the disease had done to have “God inflict this upon us?”

“The absence of hope can be devastating,” Dr. Brater said. “Seeing a friend or family return from near-death through education and therapy can do wonders.”

Joe Stuteville is editor of IU Medicine.