Aids in Africa: Treating the Patient

April 12, 2010 • Posted in Africa

R. Henry Williams, M.D., M.A., F.A.C.P.
Board Chair
The Tennessee Center for Bioethics & Culture
April 2008

Travel to a third world country can challenge one’s perspective in a lot of areas.  Having just returned from Ethiopia, where my wife and I participated in an HIV-AIDS medical project, I have some new bioethics categories to process.

The AIDS Care and Treatment (ACT) Project in Addis Ababa is a comprehensive support ministry to HIV-positive beneficiaries and their families.  Thanks to international funding programs, people with AIDS are being given anti-retroviral drugs through state-run clinics, and they are referred to the Project for assistance in compliance with medication and for other needs.  Many receive financial support and nutritional assistance, and they are given spiritual encouragement and counsel through support groups established in their respective neighborhoods.  Originally started as a hospice to help families grieve and bury their dead, the Project now serves in many capacities as patients recover from their disease and thrive.

A few years ago treating AIDS in Africa seemed an impossible, far-fetched idea, but attitudes have changed.  This may be due in part to third-world medical champions such as Dr. Paul Farmer, the Harvard professor who has devoted much of his life to caring for patients in Haiti and combating worldwide medical problems among the poor.  In Farmer’s words, a “preferential option for the poor” should be an “area of moral clarity.”  Farmer dared to begin treating AIDS in Haiti long before others thought this was feasible, much less sustainable.  He brought medicine to patients that needed treatment, simply because they were his patients, no less deserving than anyone.

The first anti-retroviral drugs were introduced in Africa in 2001.  Two years later the President’s Emergency Plan for AIDS Relief (PEPFAR), committing $15 billion  to 15 focus countries over five years, was introduced.  The magnitude of HIV in Africa remains daunting (prevalence in adults is up to 20% in countries like South Africa and Zambia), yet significant progress has been made.

Ethiopia, a country of 75 million people, has an HIV prevalence of around 2%. PEPFAR has brought increased funding to Ethiopia each year. Of 130,000 people estimated to have AIDS, 82,000 were under treatment with anti-retroviral drugs in 2007.  Several thousand of these are being served as well by the ACT Project, a faith-based mission that has been welcomed by the PEPFAR-funded clinics and recognized by the World Health Organization.  

Our work with the Project was eye-opening and encouraging.  We examined and treated Project beneficiaries in a clinical setting and visited them in their tiny, makeshift homes.  Many were the poorest of the poor of Addis Ababa, finding their only lifeline in the Project with its various means of support.  Individuals and families are being cared for in a holistic way, with compassion and respect.  Ethiopian staff members, which far outnumber expatriate workers, have been trained to offer an array of counseling and social work.  We came away greatly impressed with the Project’s work and vision.

The work of the ACT Project gives one hope that a paradigm shift could occur, away from utilitarian, cost-effectiveness analyses of African problems to focus on the care of individual patients who are dying or otherwise in need.  The world has resources to address dread diseases of all sorts, and the African pandemics can no longer be written off.  America’s funding gesture and the work of support organizations offer hope that distributive justice and good individual medical care can perhaps come full circle, finding compatibility with each other as well they should.

How sustainable will these efforts be?  Will the U.S. and other countries continue to fight AIDS, TB, and malaria equitably?  Will disease be approached with compassion, or with a token or with political motives?  Will palliative care be developed when curative means cannot be obtained?  Will individuals go and help?
International governmental aid is having a huge impact on Africa today, and hopefully it will continue, given sustained political will.  On another level, the commitment of the ACT Project, a faith-based initiative, gives the impression of real staying power, as one witnesses the vision not only of career missionaries but also of the Ethiopian leadership being trained and empowered to carry on the work.  It was a great honor to participate with those who have this vision.  May their kind multiply, in Africa and elsewhere.