In fact and fiction, US officials play games with AIDS in Africa

by Gumisai Mutume

Washington, 17 Jun 2001 (IPS) - With words reminiscent of a television show, the top US aid official has provoked calls for his resignation, gales of scientific derision, and complaints of serious problems in the Bush administration’s attitude toward the millions of Africans living with HIV, the virus that causes AIDS.

Andrew Natsios, newly installed administrator of the US Agency for International Development (USAID), used a recent news interview and subsequent testimony before Congress to explain his position that the US government need not spend millions of dollars on anti-retroviral drugs for Africa. In the process, he delivered a shocker.

“Many people in Africa have never seen a clock or a watch their entire lives.  And if you say, ‘One o’clock in the afternoon’, they do not know what you are talking about,” Natsios said. “They know morning, they know noon, they know evening, they know the darkness at night.”

At least three non-governmental organisations (NGOs) - Africa Action, Religious Action Network and Health GAP Coalition - have called for Natsios to resign.

“US officials involved in shaping international AIDS policy should have a working knowledge of African realities, as well as treatment issues,” the groups said in a letter to Secretary of State Colin Powell, demanding Natsios’s resignation. USAID falls under the state department.

“If US officials lack such knowledge, we suggest they visit any of the numerous clinics run by local health care providers, governments, and NGOs, to learn for themselves about the capacity that exists to deliver HIV/AIDS drugs in Africa,” they added.

Separately, three AIDS researchers argued in a published commentary that Natsios, by virtue of “his willingness to distort the true situation in Africa before Congress, is unfit to lead USAID and should resign.”

Powell’s office has yet to respond. Officials at USAID responsible for the agency’s AIDS strategy were said to be out on an all-day retreat Friday and could not be reached for comment, but a spokeswoman said the administrator’s concern now is to move forward.

“He had no intention to offend anyone. He is trying to shed light on problems we face. The objective of the administration along with Natsios is to save as many lives as possible,” said the spokeswoman. “Taking the focus off of prevention will ultimately cause more people to contract the disease.”

Natsios is not the only administration official to have voiced such sentiments in the past few weeks. An unnamed US treasury official was quoted in the ‘New York Times’ saying, Africans would not benefit from AIDS drugs because they lack a pre-requisite “concept of time”.

The statements have convinced Wyatt Tee Walker, president of Africa Action, that “blatant racism is becoming the defining feature of US policy toward the AIDS pandemic in Africa.”

Media commentators have noted that Natsios’s statement appeared to owe more to the television show ‘West Wing’ than to his decade’s experience working in Africa. In the TV drama, a fictitious White House official declares that taking anti-retroviral drugs is too complex and precise an art for Africans to master.

Much like the real-life Natsios, the TV character proclaimed that taking AIDS drugs is a complex venture requiring “10 pills to be taken every day at precise times” - thus presenting a formidable challenge since Africans do not have wrist watches.

The latest administration blunders came as NGOs continued to press the US administration to contribute at least $6 billion annually to a proposed $7-$10 billion global AIDS fund that is being promoted by UN Secretary-General Kofi Annan. The administration has pledged $200 million.

In ongoing negotiations on the initiative, the US government is also understood to be blocking use of the fund to acquire anti-retroviral drugs, arguing it should only be used to finance prevention.

“The administration is unwilling to spend appropriate amounts of money to help save African lives and has now stooped to using ignorant and racist arguments to justify their policies,” said Salih Booker, Africa Action’s executive director.

In his Congressional testimony, Natsios, who also seemed to borrow his words from the pharmaceutical lobby, claimed that there are no roads to deliver drugs to many parts of Africa.

Drug makers, battling to protect the prices of patented products, have argued that it would be impossible to distribute AIDS drugs to sub-Saharan Africa because of a lack of infrastructure, complexities in administering the drugs, and a lack of health facilities to monitor patients.

Natsios also argued that at least 40% of people with HIV in the United States couldn’t take the medication because they get sick from the “extremely toxic” drugs.

“This is a view shared by no one in the medical establishment today,” according to three AIDS researchers who authored a column excoriating Natsios in Friday’s ‘Washington Post’.

Even US government studies “have shown that these drugs are safe for most people and prolong life by many years,” said the researchers, Amir Attaran of Harvard University’s Centre for International Development, Kenneth Freedberg of the Harvard Medical School, and Martin Hirsch of Massachusetts General Hospital.

As to the complexity of administering AIDS drugs, they wrote, “nearly all anti-retroviral drugs are taken only twice a day - morning and evening. Sunrise and sunset are just as good as a watch in these circumstances.”

Natsios’s argument that poor infrastructure means drugs can’t be “kept frozen and all that” also is patently wrong, they added: “Not a single anti-retroviral drug on the market today needs freezing. In fact, some bear warnings not to freeze them.”

The researchers also scored Natsios and the administration for trying to distinguish between AIDS prevention and treatment, citing growing expert consensus that the two are inseparable. – SUNS4917

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