Pekka Reinikainen in Kampala and Nairobi
When David Mukasa boarded a Geneva-bound plane at Uganda’s Entebbe airport on 29 July, he was very much aware of the seriousness of his mission. Since the end of July, David has boarded lots more airplanes at many other airports as one of the four core members of the Federation’s Care and Treatment Mission Team.
The team travelled to seven African countries to study possibilities to engage national Red Cross and Red Crescent societies further in providing and supporting treatment and care to persons living with HIV and AIDS (PLWHA).
The Mission started in Namibia at the beginning of August 2003 following a period of preparatory talks in Geneva. Namibia was followed by extensive talks in Zambia, Zimbabwe, Kenya, Uganda and Ethiopia. The last visits of the Mission were to Brazzaville and Pointe Noir in Congo during the second week of September.
In November 2003, the Mission will publish a report with recommendations on how Red Cross and Red Crescent national societies might engage in providing practical solutions to the care and treatment of PLWHA in their respective countries.
David Mukasa is a coordinator at the Uganda Red Cross Society headquarters in Kampala responsible for Red Cross volunteers living with HIV and AIDS. David has publicly identified himself as HIV positive, and is one of the most visible Ugandan spokespersons for PLWHA.
David stresses that providing care and treatment to people who are HIV-positive is not an overwhelming problem in developed industrialised nations. In most cases, the society they live in manages to cover all their needs without facing immediate bankruptcy. “The problem is worst in countries where money is scarce,” he says.
“This is a moral dilemma. Access to adequate treatment and care is clearly a human right. But, how far should the Red Cross and Red Crescent proceed in taking over responsibilities which in wealthy societies effectively belong to the health authorities.”
David reminds us of the fact that in many countries, especially in Sub-Saharan Africa, governments and health authorities simply do not have the resources to put in place any sustainable national health insurance schemes that would cover for efficient HIV and AIDS treatment.
“Is it then that the Red Cross Red Crescent should take over these responsibilities from society even if no other actors from the international community are willing or able to share the tasks?” he asks.
Over 42 million human beings currently live with HIV and AIDS. Ninety-nine per cent of them live in poor countries. An estimated 6 to 9 million PLWHA in developing countries urgently need anti-retro-viral treatment (ART), but only some 300,000 currently have access to it, and half of those come from one single country, Brazil.
“In Sub-Saharan Africa, roughly 50,000 people receive proper medication. Estimated current need is over 4 million, and that figure is rising sharply,” David says.
The disparity between the number of Africans in need of ART and those actually receiving it opens up a vast commercial desert for all kinds of fraudsters to fill. Millions of dollars are spent annually by desperate PLWHA buying useless pills called “vitality booster machines” or whatever.
HIV/AIDS can be managed so as to significantly prolong the lifespan and improve the quality of life of those living with the virus. The development of biomedicine has, in fact, given rise to discussions that would have seemed surreal only a couple of years ago.
In the wealthy West, there is some concern that anti-retroviral medication raises cholesterol levels, and that the remarkably extended life span of PLWHA might eventually be shortened by coronary diseases.
For the vast majority of PLWHA, access to treatment remains the key concern. “Imagine how it feels if you know that there is a relatively reasonable solution available for your condition, but you cannot have it because it costs too much. We have millions of people in Africa thinking these thoughts every day of their life,” David says.
Pharmaceutical companies manufacturing ART medicine have recently reduced the price of their products in developing countries to a level which - these companies say – covers their actual production costs only.
“This is a significant development. It takes us one giant step forward. Unfortunately, the publicity connected to these price reductions also blurs the picture,” David Mukasa says.
But, he says, the medicine in itself is not enough: “We need an infrastructure to administer treatment and care. We need reliable access to people who need these services. In the case of Sub-Saharan Africa both are usually lacking.”
Ideally, infrastructure and access should be tackled first before pills enter the equation. “Taking ART comes with meticulously following a set of absolute rules. Sloppy solutions like taking only a third of the required amount of medication or pausing the treatment because of financial difficulties will make things worse by increasing virus resistance,” David says.
In Africa doctors can’t use the routine recommendation: ‘take your pills after or in connection with a meal,’ since in many cases there is nothing like a meal coming anytime soon.
“Unless we tackle food security issues properly, it makes little sense to solve the HIV and AIDS treatment access problem. ART pills are powerful chemical packages that put a strain on human physiology. As it is today, many African people living with HIV and AIDS are too weak to start ART even if it were be affordably available,” David explains.
The Federation Care and Treatment Mission will face scores more open questions than ready answers. “The risk of creating expectations that we cannot meet must be avoided. If there is a moral platform that we must stand on, it is that we only open such doors that can be kept open,” David Mukasa says.
The aim of the three-month mission is to identify a number of African National Societies that are to become pioneers within the Red Cross and Red Crescent Movement by engaging in HIV and AIDS treatment in their respective countries.
Within the movement there are already positive examples of such engagement. The Thai Red Cross runs a large hospital and research institute and has extensive experience in treating PLWHA with anti-retroviral drugs. The French Red Cross is operating a number of pilot ART centres in several West African countries in close collaboration with the respective ministries of health.
Care and Treatment Mission Team is led by Dr Tito Fachi, President of Zambia Red Cross and member of the Federation’s Health Commission. The core members of the team are made up by David Mukasa, Dr Henrik Trykker of the Danish Red Cross and Dr Getachew Gizaw from the Federation Secretariat. In addition, five other experts joined the team on a country-by-country basis.
Reducing the impact of HIV/AIDS
Make a donation