With a growing amount of money earmarked for AIDS, perhaps the focus needs to be broadened to encompass health care in general.
AIDS Dollars
With a huge influx of dollars earmarked for AIDS and HIV projects in the developing world, one would be remiss to overlook the fact that AIDS does not happen in a vacuum. People with AIDS in developing countries are often co-morbid for other infectious diseases such as tuberculosis and malaria. With health dollars so scarce, people are not only seeking treatment and prevention for AIDS, but also support for pediatric issues, women’s health issues, other infectious diseases, etc. Instead of narrowly focusing AIDS dollars on solely the treatment and prevention of AIDS, in many situations it may be wiser to focus on the development of the public health system and supporting structures.
Program Development
AIDS is a hot topic right now and money is forthcoming. However, no amount of money can compensate for a badly designed program. AIDS advocates need to learn from the hard-learned lessons of other efforts such as the anti-malarial movement. In one program to stop the spread of malaria, a huge amount of money was spent on bed nets which were distributed in Sub-Saharan Africa. Bed netting can go a long way to stopping the spread of malaria. However, the price can be quite prohibitive for many African families. By providing the bed nets, this barrier is overcome and families can take a first, important preventative step. However, months later, when evaluating the program, it was found that the majority of the families no longer had the netting. In fact, many of the bed nets found their way to South Africa. What had happened was that the people, because they were so poor, were selling their nets to provide food and other necessities for their families. The narrow focus of the program on malaria ended up being its undoing. By not accounting for the other factors which were in play, the program was doomed to fail despite the amount of money committed to the work.
There are a number of AIDS programs which have a more holistic approach and have been successful in the face of overwhelming challenges. One such organization is Paul Farmer’s Partners in Health. With widespread work in Haiti and sub-Saharan Africa, Partners in Health has promoted a general model which addresses many concerns. Specifically, it places emphasis on developing primary health care which is free and addressing the determinants of health through meeting social and economic needs and supporting free education. No doubt this expanded approach has been a major factor in the many successes of Partners in Health.
