My first visit to Africa in 1991 was a sobering experience. It was shocking to hear my driver explain that just 30 years before he was one of 42 children his age in his village. Now, 37 of those 42 were dead, and the major cause of death was HIV/AIDS.
What if 90 percent of your grade school friends were dead by age 40? What a tragedy!
In 2003, I spent four weeks at a hospital in western Kenya. This was even more disheartening. Medication to treat HIV/AIDS was now available for those who could afford it, but most Africans could not.
The millions of needless deaths from a now treatable disease caused despair in patients, nurses and physicians alike.
The most discouraging day in my career was spent in a small rural clinic in Kenya. That day, 24 people awaited the results of their HIV test. The first patient was a beautiful 23-year-old woman, widowed a year earlier, with two children. Her HIV test was positive. When asked if she or anyone she knew had the $25 per month to pay for the treatment, she replied that she did not.
Resources were available to evaluate and treat her for TB and yeast infections, but not the underlying HIV disease. She was told that her job was to stay as healthy as possible, and our job was to find funding for the treatment of her disease. This exact scenario was repeated 23 times. I have never felt so helpless or discouraged as I did on that day.
I returned to Kenya in 2007 and found an extensive and vibrant program for the treatment of HIV. What a change! Stories of HIV/AIDS sufferers responding to medication were abundant. The most remarkable response was called the "Lazarus effect," exemplified by a woman who, within six months of starting medication, went from a 65-pound skeleton to a much healthier 130-pound woman able to resume work and take care of her three children.
What happened? Money from organizations such as the Global Fund to Fight AIDS, Tuberculosis, and Malaria was being used to combat the three diseases causing so much suffering and death in Africa. The availability of treatment brings with it a powerful feeling of optimism.
Continued use of HIV/AIDS medication is life-saving and recognized as an effective method of preventing the spread of HIV. Unfortunately, the medication does not cure the disease it merely keeps it from destroying the body's immune system.
Since people with HIV are able to live longer, healthier lives, HIV/AIDS doesn't seem as threatening as in the past, making it easy for people and governments to decrease their monetary support of programs supplying medication to those infected.
Availability of medication is dependent on adequate funding. If maintenance medication is stopped, the virus begins to multiply, resulting in reactivation of HIV and progression to life-threatening AIDS. To have effective medicine taken away may be more destructive than never having it to begin with. Despair again replaces hope.
On Dec. 3 there is a donor-pledging meeting for the Global Fund, hosted by the U.S. in Washington, D.C., to continue the fight against HIV, TB and malaria. To support an accelerated attack on these global pandemics requires $15 billion over three years. The U.S. share of this commitment should remain $5 billion over the next three years. Dr. Mark Dybul, President George W. Bush's global AIDS coordinator and now executive director of the Global Fund, said, "We have a choice: we can invest now, or pay forever."
DeVon C. Hale is assistant dean for international medical education at the University of Utah School of Medicine.