12536: Reuters on Dr. Farmer 071202 (fwd)

[Bob Corbett <corbetre@webster.edu>]

From: PSlavin@unicefusa.org

http://abcnews.go.com/wire/Living/reuters20020711_440.html


? By Stephen Pincock

BARCELONA (Reuters Health) - The debate over how to get AIDS drugs to poor
countries has sometimes seemed complicated as experts discussed the issue
this week at the International AIDS Conference, but on Thursday one
physician showed how the problem can be tackled in a straightforward and
inexpensive way.

In 1998, Dr. Paul Farmer of Harvard Medical School in Boston, Massachusetts
and others began an HIV treatment program in rural Haiti, the poorest
country in the Western Hemisphere, without ongoing financial support from
government or major international agencies, without the high-tech tests
used to monitor disease and without extra medical staff. It currently
monitors 2,000 people, about 240 of whom are taking triple-therapy.

"It's a small project for a big problem," Farmer told Reuters Health. "But
we've done it in Haiti under adverse conditions of every description--no
roads, no communication, a rural area where you have to walk or use a
donkey to get around," he explained.

"Our position is--come on--if it can be done there it can be done
anywhere."

Despite the fact that drug prices have dropped for many in the developing
world, large treatment programs in Africa or elsewhere have not yet
materialized as governments and agencies debate issues such as whether
efforts to stop people getting HIV are more cost-effective than treatment.

"No one seems to have actually done such projects in the world's poorest
communities, although HIV is now the leading cause of young adult death in
almost all of them," Farmer said in a speech delivered at the conference on
Thursday.

"There's thus a lack of know-how regarding who should receive (anti-AIDS
drugs), what enrollment criteria would be, how to manage drug supply and
how best to monitor therapy in resource-poor settings," Farmer noted.

The Haiti project added AIDS treatment to existing HIV prevention and
tuberculosis (TB) programs without needing any extra staff. And in the
absence of expensive tests to decide when to begin treatment, the
clinicians use more straightforward approaches.

"As a clinician, if you have someone who shows up and looks like a skeleton
and does not have TB and is seropositive, what are you going to do?" Farmer
asked.

"For a lot of these patients if you are good at ruling out active TB they
are probably skeletal because of HIV and they need antiretrovirals. Even
without CD4 counts and viral load--which God knows we would love to
have--we can save a lot of lives."

To make sure people take the drugs regularly the program enrolls volunteers
from the community to visit patients every day.

"We've underlined the solidarity element of this, with one community member
serving another, one usually who is sick and the other who is
well--sometimes both with HIV, by the way--so we've called them
accompagnateurs, one who accompanies," Farmer said.

These measures mean that the drugs--which run to $122 per patient each
month for a three-drug combination--make up 75% of the cost of the program.
The other 25% is for salaries and treating acutely ill patients.

"Our own experience in Haiti suggests that, even without making claims for
reduced transmission (of HIV), it is clear that the impact of a 'low-tech'
HIV prevention-and-care project could be measured," Farmer said in his
presentation.

To illustrate the point, he showed two photographs of a man who got drugs
through the program, the first showing him emaciated with ribs and
collar-bones protruding, his skin dull. In the second photograph his normal
weight and coloring have returned.

He quoted the man: "I was a walking skeleton before I began therapy. I was
afraid to go out of my house and no one would buy things from my shop. But
now I am fine again.... My wife has returned to me and now my children are
not ashamed to be seen with me."

If Haiti gets funds from the new United Nations Global Fund for AIDS, TB
and Malaria, the program could expand, Farmer said.

"I think this is the year that things are going to change for the better,"
he added. "But I think that we also have to remember that we're playing
catch-up with what we should have been done years ago."


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