Sep 1 2006

Never Apologize

[Note: this piece is a sidebar to Star Power Trumps History in AIDS Coverage]

A study published in August in the Journal of the American Medical Association (8/9/06) found that sub-Saharan Africans are better at following drug regimens than North Americans. The authors hoped the findings would lay to rest the myth that Africans are incapable of adhering to complicated antiretroviral drug treatment programs, which had been used as an excuse to restrict the region’s access to life-saving drugs.

In a related story, the New York Times (8/14/06) reported, “Only a few years ago, there was widespread skepticism that AIDS treatment programs would work in poor countries.” But that claim is seriously misleading.

Yes, such “skepticism” was official policy. Andrew Natsios, administrator of the U.S. Agency for International Development (USAID), infamously argued (Boston Globe, 6/7/01) that treatment for the 25 million Africans living with HIV/AIDS simply “couldn’t get done,” claiming that Africans

don’t know what Western time is. You have to take these [AIDS] drugs a certain number of hours each day, or they don’t work. Many people in Africa have never seen a clock or a watch their entire lives. And if you say, 1 o’clock in the afternoon, they do not know what you are talking about. They know morning, they know noon, they know evening, they know the darkness at night.

Such an attitude was in service to the U.S. government line that developing countries should not be allowed to undermine pharmaceutical companies’ profits through the distribution of generic versions of patented drugs—since their lack of infrastructure and general backwardness would make the distribution of such drugs wasteful or worse.

That view was met with media credulity. ABC World News Tonight even ran a story (7/8/99) implying that it was better for Africans to die than to have access to cheap AIDS drugs. Having introduced a Zambian AIDS patient named Veronica, ABC reporter Richard Gizbert claimed: “The newest drugs are hard to get here as well. But even if they were available, Zambian officials believe it is better to let someone like Veronica die than to give the drugs without the proper supervision.” No evidence was presented indicating that this was the position of the Zambian government.

Of course, some pundits needed no prodding to pick up on the storyline of Africans too benighted to be helped. Fox’s Bill O’Reilly (3/15/01) told a guest:

When you say you have to change the behavior of the people, that’s not realistic because . . . tribalism and superstition dominate everywhere, there is no infrastructure, they don’t have television, most don’t have radio, there are no newspapers. It’s just about impossible. This is why this AIDS epidemic has exploded in Africa because, as you said, many people say, “I’m not going to get it because I rub this kind of berry juice on me, and that’s going to protect me.”

But adherents in the government and the press corps, no matter how loud-mouthed, still don’t make a position “widespread.” Doctors, activists and regional experts always contended that Africans could successfully administer HIV/AIDS treatment programs.

Reporting for the Chicago Tribune in 1999, Merrill Goozner noted (4/28/99) that physicians who treat AIDS in developing countries called warnings about the dangers of improperly supervised treatment a “false issue.” Goozner cited Mark Biot of Doctors Without Borders as saying that “clinics in most of the larger cities of the developing world would be fully equipped to handle AIDS patients if they had access to affordable tests and drugs.”

The new JAMA study, says Ann-Louise Colgan of Africa Action (L.A. Times, 8/9/06), only “makes clear what many of us have argued for a long time.”

Advocates for Africans with HIV/AIDS weren’t listened to. That doesn’t mean they didn’t exist.