AIDS and Africa: Where is the US

By Sonia Ehrlich Sachs and Jeffrey Sachs, 2/4/2002

LANTYRE, Malawi -

THE SIGHT WAS shocking. Peering into the medical ward of Queen Elizabeth

Hospital was like peering into a corner of hell. AIDS has overtaken the hospital.

Seventy percent of the medical-ward admissions are AIDS-related, but the hospital

lacks the proper medications to treat the sick. So the patients come to die in ever

increasing numbers, far beyond any capacity to manage. Two to a bed; sometimes

three to a bed. When the beds overflow, the next wave of the dying huddle on the

floor under the beds, to stay out of the way of families, nurses, and doctors passing

through the wards. The constant low-level moans and fixed gazes of emaciated

faces fill the ward.

These patients are dying of poverty as much as they are dying of AIDS. In the next

corridor is an outpatient service that offers AIDS drugs. Four hundred or so

patients are successfully being treated with antiretrovirals. They are the tiny fraction

who can afford to pay approximately $1 per day out of pocket for the medicines.

The treatment has been successful. CIPLA, the Indian generics producer, supplies

the drugs; the patients take them twice a day; and they get better. No great

complexity, no unusual complications of toxicity, no struggles to achieve patient

adherence to the drug regimen. Just a doctor prescribing medicines, and his

patients responding.

A few miles away, one sees the implications of the dying fields that Africa has

become. A village in Malawi is like a giant orphanage, in which a few elderly and

wizened grandmothers look after the children of their dead and dying sons and

daughters.

Enter a village and suddenly one is surrounded by dozens of children, a handful of

elderly, and almost nobody of working age. On the day of our visit, it turns out, the

few remaining men are off to a funeral. The grandmothers talk softly of their lost

children as their orphaned grandchildren squat quietly nearby.

One grandmother shows us the rotting, bug-infested millet that she will use to make

the gruel that keeps her and her wards barely alive. A beautiful young girl proudly

tells us that she is in the second grade. She walks barefoot 3 kilometers early each

morning to get to school. She wants to go to college, says her grandma. To make

it, she will have to beat forbidding odds.

The rich world is an accomplice to the mass deaths in Africa. Why aren't US

leaders visiting the hospitals, villages, and health ministries in Africa to ensure that

the United States is doing all it can do to stop the deaths? Why aren't US leaders

talking to African doctors? We are spending tens of billions of dollars to fight a war

on terrorism that tragically claimed a few thousand American lives. Yet we are

spending perhaps one- 100th of that in a war against AIDS that kills more than

5,000 Africans each day.

A report of the Commission on Macroeconomics and Health of the World Health

Organization shows that a tiny share of rich-country income - one penny of every

$10 of GNP - would translate into 8 million lives saved each year in the poor

countries.

The rich world is running out of excuses. Every misconception we've heard about

treating AIDS patients - that the drugs don't work in Africa, the patients wouldn't

adhere to ''complex'' regimens, that the doctors aren't qualified or can't be trained -

has been matched by similarly lazy misconceptions about foreign assistance.

We've been told that any aid would be wasted, that debt relief would be

squandered by corruption. We've been told that it's not ''cost effective'' to spend a

tiny fraction of our own income to save millions each year, as if it's cost effective to

let a generation die, to allow the collapse of Africa's tottering health care system,

and to stand by as tens of millions of children are orphaned.

Debt-relief foes in Congress have warned that the benefits of debt cancellation

would never reach the poor. We found the opposite. In each country that we

visited on this trip - Malawi, Uganda, Ghana - the government is pursuing a

meticulous and transparent process to ensure that budgetary savings from debt

relief are actually channeled into urgent social sectors. The problem is not waste or

corruption, the problem is that the extent of help from the United States and

Europe is so meager in the face of the enormous crisis.

In a small room in Uganda, the intermingling of beauty and unnecessary suffering

touched us more deeply than we could have imagined. A singing troupe of

HIV-infected individuals, all likely to die in the next few years for lack of access to

life-saving meds, sang to us with great power, charm, and bravery of their

struggles.

Rock star Bono, traveling with our group, reached for his guitar. With haunting

beauty, he responded with his magnificent ballad ''I Still Haven't Found What I'm

Looking For.'' The Ugandans swayed rhythmically to his pure and gripping tones.

The tears flowed freely.

The US complicity in Africa's mass suffering, unless reversed, will stain our country.

Africa is the place where we will confront our own humanity, our morality, our

purposes as individuals and as a country.

Sonia Ehrlich Sachs is a pediatrician. Jeffrey Sachs is director of the Center for

International Development at Harvard University and chairman of the Commission

on Macroeconomics and Health of the World Health Organization.

This story ran on page A27 of the Boston Globe on 2/4/2002.