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2.         To date, an estimated 50 million people have contracted HIV; about 25 million people in sub-Saharan Africa are infected, and about three million of these people die annually. In some countries, average life expectancy has fallen by more than a decade because of HIV/AIDS. By 1985, many epidemiologists were already warning about the scale of the global AIDS epidemic.  Unfortunately, it has been only in the past two or three years that the gravity of the AIDS problem in Africa and other parts of the developing world has been fully recognized by those in the best position to do something about it; this includes many African presidents and prime ministers as well as Western government leaders.

3.         Perhaps it should not surprise us that the AIDS crisis in Africa in particular has taken so long to become a matter of concern at such high political levels. The post-World War II history of the West's relationship with Africa suggests that   when    millions    of    Africans    die, or when African states collapse, Western leaders often look away.  In fact, during the cold war, the US actively supported regimes in Liberia, Zaire, and South Africa that were responsible for the deaths of thousands of their citizens.  The US and Western Europe failed to intervene during the Rwandan genocide, and had it not been for a group of rock stars, Americans and Europeans might well have ignored the Ethiopian famine in the 1980s.  Moreover, diseases like malaria, respiratory infections, measles, and diarrhea, all preventable or curable and largely controlled in the West, continue to kill millions of African children, and yet US overseas bilateral aid to Africa fell by half in the 1990s.

4.         In contrast, throughout the 1990s, US funding for HIV prevention in developing countries averaged some $70 million per year.  Why did AIDS in Africa at last grab the rich Western world's attention? Why haven't similar deadly scourges of the third world done the same?

5.         For many reasons, the suffering of African AIDS patients has drawn international sympathy in a way that the suffering of malaria and diarrhea victims do not. For one thing, AIDS is a manifestly "global" disease; by the time it was first recognized in the early 1980s, HIV had already spread to nearly every continent. It has killed people of all races and classes, from the economically flourishing gay neighborhoods of San Francisco and New York to the poorest slums in Africa, Asia, Latin America, and the Caribbean.

6.         Indeed, AIDS is part of a wave of infectious, environmental, and behavioral pathologies that have accelerated in recent years. Some of these may be seen as "diseases of globalization" because they affect all countries and their ultimate control will require unprecedented global cooperation.  During the past two decades, more than two   dozen new infectious agents have been identified, along with new environmental health problems like global warming and ozone depletion. In addition, health problems associated with hazardous behavior, such as drug abuse, unsafe sex, traffic accidents, and violence, have also increased, particularly in societies undergoing rapid social change. The global distribution of these emerging diseases may explain why AIDS in particular is no longer seen as just another "third world" problem that people in the West feel they can largely ignore.

7.         The new awareness of AIDS has highlighted some troubling issues surrounding the global influence of private markets and the spread of infectious diseases. The collision between these two trends has created a moral problem. Since 1996, HIV-positive patients in rich Western countries have had access to "cocktails" of drugs called antiretrovirals that can slow the progression of AIDS. These drugs are designed to attack the HIV virus, allowing the patient's immune system to repair itself and fight off opportunistic infections. Although the drugs do not cure AIDS, can have serious side effects, and do not work for all patients, their use has added many healthy years to the lives of thousands of people living with HIV in rich countries.

8.         Partly because they are so expensive, these life-saving drugs are largely inaccessible to the world's poor, especially the millions of HIV-positive people in Africa. One reason they are expensive is that international trade rules allow pharmaceutical companies a twenty-year patent, which effectively grants them a monopoly. During this time, the companies can charge whatever the market will bear.

9.         Patenting drugs that could, if they were cheaply available, extend the lives and postpone the suffering of thousands or even millions of poor people in developing countries raises serious ethical concerns. The development of antiretroviral drugs and  awareness of the moral   issues involved owe a great deal to gay HIV activists in rich countries, particularly in the US, who, beginning in the late 1980s, picketed the US National Institutes of Health (NIH) demanding that more money be spent on AIDS research. The activists demanded that the Food and Drug Administration accelerate the regulatory approval process for promising drugs. And they claimed the pharmaceutical industry set exorbitant prices to enrich their shareholders while ignoring the plight of the world's poor. Why, they asked, were these life-saving drugs, now finally available, so expensive? Could they not be sold more cheaply to HIV-positive people in poor countries?

10.       Concerns about the high cost of drugs in general have led to increased public scrutiny of the pharmaceutical industry, and this is beginning to pay off. Activists calling for greater use of generic drugs in poor countries with serious public health problems recently won a number of concessions.  In addition, indignation over the high cost of AIDS drugs has helped focus international attention on the global AIDS epidemic and by the end of 2001, an antiretroviral drug cocktail could be obtained in   some   developing   countries  for $300 to $500 per year, many times less than the price in the West. However, for a variety of reasons, including the sluggishness of government bureaucracies, the stinginess of drug companies, and the fact that even at these low prices the drugs are still too expensive and difficult to distribute, few AIDS patients in developing countries are actually receiving these drugs or, for that matter, any modern medications at all beyond the cheapest antibiotics.

11.       With this dilemma in mind, the UN recently launched the Global Fund for AIDS, Tuberculosis, and Malaria. Difficult decisions will have to be made about how to allocate its limited resources to prevent and treat these three diseases. Opinions vary, for example, about   how much of the Global Fund should go to pay for AIDS treatment. Last year, a group of Harvard academics proposed that some of the money be spent on buying discounted antiretrovirals from Western pharmaceutical firms. They cited various small-scale AIDS treatment programs including ones based in Haiti and South Africa as evidence that administering antiretroviral drugs to poor AIDS patients in developing countries is feasible.  The greatest obstacle, say the directors of these programs, is the cost of antiretroviral drugs.

12.       These small pilot projects are admirable and offer many practical lessons and hope, but there are grounds to question whether they could easily be extended throughout sub-Saharan Africa. Both the Haitian and South African projects are currently administering antiretrovirals to only around one hundred patients each, while there are millions of people in Africa alone who might benefit from antiretrovirals. But experience shows that distributing even relatively simple drug regimens on such a large scale poses   formidable   obstacles. Programs in developing countries that aim to treat people with syphilis and tuberculosis, or even to distribute Vitamin A supplements to children, show how difficult it is to deliver health care in such countries, even if the drugs are free or nearly so. An estimated 1.6 million women who give birth every year in those countries have syphilis, a disease that puts their newborns at high risk of deformity or death, even though the tests and drugs to treat it cost only about twenty-five cents. Hundreds of thousands of children go blind every year, and more than a million die, because they are deficient in Vitamin A. Vitamin  A supplements, which need to be taken   only   twice   a  year,  are  virtually  free.

13. Of course some treatment and vaccination programs have been very successful, for example those for smallpox, polio, and onchocerciasis ("river blindness"), but vaccines for polio and smallpox need to be administered only a few times in a lifetime, while the oral dose to prevent the onset of onchocerciasis symptoms is taken once a year; and the recipients of such treatment, unlike AIDS patients, do not require ongoing care. And even these relatively simple programs have required enormous donor commitment and funding over long periods.

14. The failure to deliver some even very cheap, simple treatments in developing countries is largely owing to the lack of sufficient trained and motivated health personnel, inadequate management and administrative capacity, and insufficient supplies of vehicles, refrigerators, lab reagents, and other basic equipment. For example, syphilis screening and treatment in antenatal care requires adequate staffing, an efficient referral system, reliable supplies of testing materials and drugs, an on-site rudimentary laboratory with quality control, and other resources that a great many health centers in poor countries simply do not have.

15.       Treating AIDS patients is far more complicated than testing for syphilis or administering Vitamin A drops.  AIDS  patients

need counseling, laboratory tests, and ongoing clinical care to treat opportunistic infections and monitor drug side effects. Even if the drugs and other necessary supplies were available, and in most cases they aren't, antiretroviral treatment programs require considerable effort on the part of public sector health workers. But because of political instability, economic stagnation, and misguided health sector reform policies mandated by donor institutions such as the World Bank, the health workforce throughout sub-Saharan Africa has been collapsing.  Thus, any effective AIDS treatment program must endeavor to strengthen the health care system generally, especially the human infrastructure of front-line health workers, as well as meet the concerns of people affected by AIDS.

16.       While antiretroviral drugs are important, they are not a panacea for the AIDS crisis in Africa. Indeed, the debate over the high cost of the drugs has made AIDS in Africa appear to many to be merely a medical problem, when it is in fact far more than this. This is because AIDS kills and weakens the adults who grow the food and earn the money that supports everyone else. The dependency ratio in Africa is much higher than it is in the West, not only because there are so many young children, but also because there are so many unemployed people, and most countries have no social safety net. When a South African mine worker, for example, becomes sick or dies of AIDS, he may leave behind in his rural home village as many as ten or twenty destitute dependents, including children, wives, in-laws, brothers and sisters, parents and grandparents. Antiretroviral drugs could help some of the mine workers stay healthy longer, but the drugs have side effects of their own, they don't work for everyone, and they are certainly not a cure. Eventually, the family will need other kinds of help, including money for children's school fees and seeds, small loans, or help finding jobs and business advice, so that survivors can start small enterprises.

17.       Overemphasis on the medical aspects of AIDS in Africa probably arises from the tendency to see the problems of the developing world as reflections of problems in the West. But many small African AIDS groups see AIDS quite differently. They provide a wide range of social support and HIV prevention services, in addition to rudimentary care for AIDS patients. Emphasizing access to AIDS drugs alone risks bypassing much of the very good work that these groups are already doing.

18.       Nevertheless, a strong case can be made that the pharmaceutical companies should either donate their drugs to Africa entirely for free or permit the use of generics, in exchange for some guarantee that their markets in industrialized countries will be protected. The companies can well afford to do this. A similarly strong case can be made that projects like the Faraja Trust in Morogoro, Tanzania, or the Friends of Street Children Project in Kampala, Uganda—to name just two of thousands of such groups in East Africa alone—should get most of the support from the Global Fund. Antiretrovirals could then be part of such programs whenever feasible.

19.       The governing board of the Global Fund seems to recognize the importance of both national health systems and nongovernmental programs that strive to meet the complex and specific needs of particular communities. Under the fund's guidelines, made public at the end of January 2002, National AIDS Coordinating Councils, quasi-governmental bodies that include members from nongovernmental organizations, will submit proposals to the fund, and the money will be disbursed to the government, which will then pass the money on to nongovernmental entities. However, there are already concerns that many groups will be overlooked. Cronyism and corruption, perennial problems with international aid in general, will also have to be addressed, but as yet, it is not clear how this will be done, or how the spending will be monitored.

20.       Addressing the AIDS crisis in Africa will require an emphasis on more than antiretroviral drugs alone, important as they are. What sub-Saharan Africa seems to need even more than it needs AIDS drugs is the improvement of its health care systems, the creation of livelihoods for families impoverished by AIDS illnesses and deaths, and the alleviation of the loneliness, poverty, and despair  that are  likely to motivate risky sexual behavior. The Global Fund cannot deal with all this on its own. Until scientists discover an effective vaccine to prevent HIV infection, sustained relief from the African AIDS epidemic may depend on the subcontinent's social and economic stability, which in turn will depend on better governance by Africa's leaders. But it will also depend critically on greater support for Africa from the international community.

21.       Nevertheless, it is of enormous importance that the Global Fund succeed, not only because it could reduce much human suffering, but also because it could advance the credibility of new mechanisms to manage the negative consequences of globalization. If the fund's performance were to generate cynicism, it could undermine similar efforts in other areas. If successful, it could become a model for global governance in the future.

 

 

What Can Be Done About AIDS? 

Sample Questions 

1. Why do the writers bring the statistics in paragraph 2?

a. To show that AIDS has gotten worse in recent years.

b. To explain why only recently people have recognized the problem.

c. To illustrate that AIDS is worse than malaria and tuberculosis.

d. To demonstrate the seriousness of the AIDS problem.

 

2. Why wasn’t the AIDS pandemic taken seriously before it became a global problem?

a. Because other difficult diseases continue to kill millions

b. Because the west did not intervene in the Rwandan genocide

c. Because it did not affect the western countries

d. Because the problem was not serious enough before it was global

 

3. In paragraph 6, drug abuse and traffic accidents are mentioned as examples of which type of problem?

a. an environmental pathology

b. a behavioral pathology

c. a third world problem

d. a first world problem

 

4. How have the problems mentioned in paragraph 6 affected countries’ attitudes towards AIDS?

a. They show countries that AIDS is different from these problems.

b. They show countries that AIDS is a growing problem, just like the other ones.

c. They show countries that AIDS is just another “third world” problem.

d. They show countries that AIDS can no longer be ignored.

 

5. Paragraphs 7-9 discuss how the collision between the trend of global influence of private markets and the trend of the spread of infectious diseases has created a moral problem. What is the moral problem?

a. AIDS drugs are designed to save the lives of AIDS patients, but they do not cure AIDS, and have serious side effects.

b. Even though life-saving drugs are available to rich patients in Western countries, they are not available for poor patients in Africa.

c. Even if the AIDS drugs were cheap, they still would not be accessible to poor HIV-positive people in Africa.

d. HIV activists in rich countries only made efforts to help AIDS patients in Western countries while ignoring the world’s poor.

 

6. Which group is supposed to be responsible for helping drugs become available faster?

a. The gay HIV activists in rich countries

b. The National Institutes of Health

c. The Food and Drug Administration

d. The pharmaceutical companies

 

7. What is one of the results of the protests against the high cost of AIDS drugs?

a. People in poor countries may purchase AIDS drugs at a reduced price.

b. People in developing countries are actually receiving the AIDS drugs that they need.

c. More poor countries with serious health problems will get AIDS drugs for free.

d. Pharmaceutical companies are beginning to pay for the AIDS drugs in poor countries.

 

8. What dilemma caused the UN to create the Global Fund for AIDS, Tuberculosis, and Malaria?

a. Although the price of AIDS drugs has been reduced, not many patients in developing countries have access to the drugs.

b. Although AIDS drugs could be obtained in some developing countries, it is not available in other poor countries.

c. Although the AIDS drugs are now cheaper in developing countries, they are still too expensive in developed countries.

d. Although AIDS drugs are now available for patients in developing countries, there are still major problems with obtaining drugs for tuberculosis and malaria.

9. Why do the writers discuss Vitamin A and syphilis treatments?

a. To show that when treatments are cheap or nearly free, people are less likely to take them.

b. To demonstrate the difficulty in dispensing medical treatments to people in African countries.

c. To emphasize that AIDS treatment is more complicated than treatments for Vitamin A and syphilis.

d. To prove that AIDS is not the only difficult disease that must be treated in African countries.

 

10. What is the general topic of paragraphs 7 through 12?

a. Ethical problems that are caused by the African governments

b. The advantages and disadvantages of various AIDS treatments

c.  Problems that arise in dealing with the AIDS epidemic in Africa

d.  The negative influence of globalization on the fight against AIDS

 

11. What consequence of AIDS is the focus of paragraph 16?

a. The need for employment for the AIDS patients

b. The suffering of the AIDS patients while sick

c. The economic needs of the patients’ families

d. The pain of the people left behind when a patient dies

 

12. What is the purpose of paragraphs 16-17?

a. To show that improving access to AIDS drugs is not enough to solve the problem

b. To show the effect of AIDS on the family members of the patients who have it

c. To show that AIDS in Africa is different medically than AIDS in other countries

d. To show that AIDS in Africa is primarily an economic problem, not a medical one

 

13. The authors give recommendations for dealing with the AIDS crisis. Which one of the following statements is true according to the text?

a. Money from the Global Fund should mostly support government agencies dealing with the AIDS crisis.

b. Because African governments have problems with corruption, the Global Fund should distribute the money directly to particular communities.

c. The main focus of the programs should be on research to find an effective vaccine to prevent HIV infection.

d. The quality of African governing policies must be improved in order to help with the crisis.

 

14. According to the writer, what is the indirect implication of the success of the Global Fund?

a. The Global Fund will help to undermine future efforts at global disease control.

b. The success of this program will bring the suffering of many innocent people to an end.

c. The treatment of AIDS can provide a model for dealing with other global issues.

d. The success of the Global Fund in dealing with AIDS will prove that globalization is not negative.

 

15. What is the main idea of this text?

a. The problem of AIDS in Africa can be managed, but it will require a multifaceted approach including international cooperation.

b. The problem of AIDS can probably not be solved, since acquiring drugs and implementing treatment are expensive and complicated.

c. The global nature of the AIDS epidemic necessitates immediate funding to solve the problem.

d. The Global Fund can succeed in dealing with the AIDS crisis in Africa if the drugs can be made more affordable.