Stop AIDS, Stop Zika, Stop Them All

Struck with a prolonged and worsening illness, Faith, a 37-year-old Nairobi woman raising her two children, sought help from local clinics. She came away each time with no diagnosis and occasionally an absurdly useless packet of antihistamines. Finally, a friend urged her to get an HIV test. When it came back positive, Faith wanted to kill herself, and got hold of a poison.

All epidemics arise from weak health systems, like the one that failed to serve Faith. Where people are poor and health systems are under-resourced, diseases like AIDS, Yellow Fever, Ebola, TB, Zika, Malaria, steadily march the afflicted to an early grave, decimating families, communities and economies along the way.

Since the beginning of the HIV/AIDS epidemic alone, over 34 million have died, leaving 25 million children orphaned. Strong or even adequate health systems would have prevented this tragedy.

A strong health system seeks to provide the largest numbers of people with the most opportunities to stay healthy. This requires infrastructure that many regions, countries and communities lack--well-supplied hospitals and clinics, research capacity and a skilled workforce. But it takes more than medical solutions.

Public health approaches with community connections are essential to inform the public about available treatment for diseases and how to prevent their spread. South Africa, for example, has announced a 3-year HIV awareness campaign focusing on girls and young women between 15-24 years, and the men who are infecting and impregnating them. It will cost $3 Billion ZAR (over US $200 million) funded by the government with help from international donors.

Countries across the globe have made tremendous progress in loosening HIV's stranglehold on the world's poor. Millions more people are on treatment and deaths have decreased even in the most impoverished and HIV-ravaged regions in Africa, yet a staggering 37 million people worldwide are living with HIV, with over 2 million newly infected just last year. Stigma continues to ostracize people from their homes and communities such that mothers like Faith would rather be dead than face her HIV diagnosis.

The problem is not only elsewhere; it's here in America. Poor communities in the southern states happen to be home to the nation's highest HIV rates.

The United Nations has called for the end of AIDS by 2030, a goal that should be realistically attainable since we now have the tools to defeat the disease. We have learned that successful antiretroviral therapy (ART) suppresses the HIV virus and dramatically reduces transmission.

No longer waiting for an HIV-positive patient's viral loads to increase, countries are rapidly adopting the "test and start" protocol which begins treatment as soon as a person tests positive. Another innovation--PrEP-- prophylactic medications combined with outreach and prevention strategies--is under way among people who are substantially at risk. They include men who have sex with men, people who inject drugs, sex workers, couples where one partner is HIV-positive, transgender people and women and girls. Self-testing for HIV is gaining ground too; the more who learn their status, the more we can treat--and the more transmission arrested.

The new approaches are working. With daily adherence to medication, a person can enjoy a long and healthy future. When Faith found this out, she traded in the poison for a new lease on life.

While the UN 2030 target merits optimism, we have to answer tough questions: How will we reach HIV-positive people if there are no clinics for people to get tested at or treated, especially in rural areas? Or, what if there are clinics, but no supplies? Or clinics, and enough medications, but too few trained medical personnel to serve everyone who shows up? Or, if there are no prevention and outreach campaigns to dispel shame, how will we encourage those who most need testing and treatment to seek it--rather than remaining ignorant, untreated and a sexual risk to others?

What good are targets then?

What countries need to battle AIDS is the same as what's needed for Zika or any emerging diseases. They need support from institutions in wealthy nations--funding that isn't split between diseases but investments to fight them all, at once, while providing basic care that keeps people healthy.

There are models. Through the Global Health Security Agenda, a global initiative to strengthen health systems worldwide, countries from Peru to Uganda are working to openly assess and improve theirs. With the opening of a new healthcare skills and training institute, GE Healthcare recently committed to training over 10,000 healthcare professionals from across East Africa at its new facility in Kenya. The U.S. Centers for Disease Control (CDC) is partnering with the African Union to create the new African CDC to capacitate countries to address complex health challenges. Just this week, the World Bank announced the first of a series of investments to improve human and animal disease surveillance and health systems in West Africa following the Ebola crisis. There are many such examples--yet many more are still needed to diminish the microbial threat to humanity.

We can have all the medications and knowledge available to heal the sick, but if we don't build strong health systems, we will continue to see AIDS and other epidemics cause needless illness suffering, and death, while crushing economies. We can enable people and countries to thrive, or continue to lurch from one public health crisis to another instead of stopping them all.
___
ABOUT THE AUTHOR: Dr. Jonathan Quick is President, Management Sciences for Health, a Harvard Medical School faculty member, and author of The End of Epidemics: The looming threat to humanity and how to stop it. (St. Martin's Press/Macmillan, U.S. and Scribe, UK and Australia, 2017)