|Anthony S. Fauci, M.D.|
On the train ride back to Washington, D.C., I queried Dr. Fauci about the challenge of getting AIDS patients to adhere to their medicines. He acknowledged the need, noting, 'We have to do behavioral intervention along with the biological.'
While Dr. Fauci and other panelists voiced very high levels of optimism regarding the impact of the HPTN 052 Study and the prospect of treating many more AIDS patients, some individuals and organizations I contacted who work with AIDS patients in developing countries expressed reservations related to:
Motivation. Treating individuals earlier in the disease stage, while ideally much more effective, also runs into human nature: Those who haven’t experienced the symptoms of the disease may be less motivated and disciplined in treating the disease. And the mistaken idea that 'a pill will fix you if you get it' can actually inhibit the cautious behaviors that help prevent acquiring HIV.
Stigma. In developing countries, both testing and treatment still face significant obstacles related to stigma. In a few African villages, for example, pretty much everyone knows when someone begins treatment, in part because they often have to travel far to get the medicines. That makes individuals think twice before venturing forth for testing or treatment.
Money. Because of funding cutbacks, too many patients who began receiving ARV treatment initiated through the PEPFAR program under the Bush administration now either have lost access to their medicine already or may lose it soon. With the economy not improving quickly, it’s hard to assure that adequate funding will be available to not only bridge the existing gap but also ramp up yet more treatment to reach individuals earlier in the disease stage.
Adherence. As one AIDS expert I corresponded with noted, 'You’re running the risk of dramatically adding to the pool of resistant strains of the virus due to lack of adherence.' Jeffrey Crowley, Director of the Office of National AIDS Policy and Senior Advisor on Disability Policy at the White House, echoed this concern, warning during the panel discussion of the need to 'take a tough look at how we’re supporting people in adhering to their medicines.'
Mistrust. Both testing and treatment depend upon the acceptance of science, and many individuals in developing countries still do not trust science or scientists. That’s a key area where faith-based organizations can help. A Gallup World Poll of sub-Saharan Africans in 19 countries about their confidence in eight social and political institutions found that religious organizations enjoyed the highest levels of confidence (76 percent). The World Health Organization released a report revealing that between 30 percent and 70 percent (varying by country) of the health infrastructure in Africa is currently owned by faith-based organizations. That report noted that 'efforts are needed to encourage greater collaboration between public health agencies and faith-based organizations (FBOs), if progress is to be made towards the goal of universal access towards HIV prevention, treatment, care and support.'
I came away from the U.N meeting with the sense that while government officials are understandably excited about the potential of earlier treatment, concerted effort needs to be directed toward (a) addressing the current and projected funding deficit, and (b) partnering with proven effective faith-based professionals and organizations in the field that can help address implementation challenges."