Seeking fresh new approaches to global health policy, the CSIS Commission on Smart Global Health launched a contest to attract innovative ideas that work. The Commission on Smart Global Health knows that front-line global health professionals, volunteers, and students have a wealth of expertise and offered scholarships or prizes and publication to the best responses. Entrants needed only to answer one question: What is the most important thing the U.S. can do to improve global health over the next 15 years?
When people think of Africa, most of the time, the first thing they think of is HIV/AIDS. Images of the defeated, broken, sick and desperate, children left orphaned, and the elderly utterly helpless, come to mind, and the general picture painted is a rather depressing one. In a lot of ways, that's a pretty accurate assessment. The HIV/AIDS pandemic in Africa shows few signs of letting up, and while the rest of world panics about H1N1 (which is not to be trivialized either), it's easy to forget the fact that an epidemic has ravaging Africa and developing countries for years, killing millions, the effects too many to count. By all outward appearances, it seems like a remarkably bleak situation.
Well, therein lies the problem: it's not bleak, it's not hopeless, and it's certainly not a lost cause. I come from Kenya, where almost 10 percent of the population is HIV positive. For most of my life I lived in Botswana, a country with some of the highest HIV/AIDS statistics in the world – 24 percent of the adult population is HIV positive. In all my time there though, I can't say that what I saw in the faces of people who had the disease was depression, misery, or desperation, I saw hope. I saw people who were alive, not walking corpses waiting to die, but people living in spite of the adversity they faced. I believe they are the bravest, strongest and most resilient examples of humanity, not because they weren't ever scared, or they never had times where they wanted to give up, when the disease felt completely overwhelming, but because somehow, they manage to overcome these things in extraordinary ways. I remember my secondary school Agriculture teacher, the funniest, most enthusiastic teacher I had. He made me, a thoroughly squeamish person, learn to appreciate the wonder of a calf being born, the joy of taking care of rabbits, and the satisfaction in looking after sick chickens. He was the first person that ever told me that I would make a good doctor. I never knew he had HIV/AIDS. Mr. K, my cheerful, encouraging teacher, the man full of energy, who practically came running into class from the garden, had HIV/AIDS.
Those living with HIV are not inmates on death row;they have hopes, dreams, aspirations. HIV/AIDS – as appalling as this sounds – isn't going to just magically disappear. It's simply unacceptable that their lives get cut short by preventable diseases like tuberculosis, with a full drug course that costs about ten dollars. The problem is usually a lack of access to proper medical care, to adequate nutrition, and even just clean water. This not only contributes to the virulent spread of the disease, but it cuts down the time patients have by a significant number of years.
This pandemic is not going to be a, “People wake up one day and realize...”, sort of thing, and the disease just goes away. We cannot decide that the best way to deal with it is to just ignore the problem, to let it run its course, hope it just peters out one day. Treating HIV is about being pro-active in preventing the onset of AIDS, and until the global community takes such an approach, the disease threatens to grow exponentially.
Foreign aid, like money and medication is great, until it either runs out or becomes exorbitantly expensive to those in need because of corruption and theft. The same goes for volunteers and foreign health professionals – eventually they leave. A few months or years of work is erased by the resurgence of the exact same problems.
The solution is really very simple; just make it permanent. Instead of bringing volunteers to treat and tend to the sick, let them train people in struggling communities to do it themselves. Accelerated nursing programs can take about a year for anyone with high school level education, and nurse aide training just six weeks for those with basic literacy. Instead of throwing money at corrupt politicians, construct the medical and infrastructural support desperately need in rural areas. Implement agricultural initiatives that encourage subsistence farming and self-sufficiency have worked in countries like Botswana, where instead of getting GM food rations from foreign aid, communities grow their own food and if necessary, receive supplements from the government. Pharmaceutical companies can invest in large towns by having branches there, which create more jobs and income, and would allow more direct access to medication. It's also more profitable for those companies because labor costs are much lower and the demand for medication is very high. The most effective way of treating a disease is to empower the patients.
HIV may not have a cure, but it has many treatments, and they can prolong lives for many more years. Just because we can't kill HIV/AIDS doesn't mean we should allow it to kill. People with HIV/AIDS live positive lives, it's the least the world can do to be as positive as they are. They haven't given up on beating the disease, so why should everyone else?