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Dispatches from Nigeria on AIDS and Abstinence

Last week, the 14th International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA) took place in Abuja, Nigeria. Despite the disproportionately high burden of these diseases on the African continent, ICASA typically gathers modest media coverage, and a recent, tragic plane crash in southern Nigeria ensured that the event was relatively neglected in the international press. All the more reason to briefly profile two hot themes emerging from this year’s conference: abstinence as HIV prevention strategy and access to second-line AIDS drugs.

Abstinence is obviously a politically heated topic, considering that the ‘just say no’ approach is predictably favored by the Bush Administration, a major funder of HIV prevention programs in Africa, while the actual effectiveness of abstinence promotion is deeply questioned by the scientific community. It is no small irony that Winnie Madizikela-Mandela should appear at the ICASA conference as a vocal proponent of abstinence, given her personal struggles with abstinence when her husband Nelson was languishing on Robben Island, and her issues with old-fashioned fidelity after his release from prison in 1990. Perhaps in this sense she functions as a symbol of the conflict between the allure of purity and the reality of human desire, though I doubt that she (or her followers) see things quite this way.

Access to first-line AIDS drugs in Africa is very limited – according to recent WHO figures, less than 10% of AIDS patients in need of anti-retrovirals in Africa are now on treatment. So it is deeply worrying to learn that a percentage of whatever ‘lucky few’ manage to gain access to first-line drugs will need to switch to more expensive second-line regimes, which pharmaceutical companies are not marketing in Africa (because poor people are poor consumers) and for which no generic equivalents are being produced. According to a presentation at ICASA by Doctors without Borders, standard first-line therapy currently costs $194 per year, while second-line treatment costs approximately 8 times as much ($1661). Toronto’s Globe and Mail are carrying a piece on this issue.

It is discouraging to realize that new efforts to lower prices for second-line AIDS drugs will have to be launched when the vast majority of AIDS sufferers in Africa still cannot get the first-line treatments, and while AIDS patients in developed nations virtually have universal access to treatment -- first-line, second-line and beyond. There is just no way around it: the abiding problems surrounding access to AIDS treatments are unlikely to be overcome without narrowing global inequalities.

-Stuart Rennie