Friday, August 12, 2005

Asleep at the wheel 

I hate to lead into the weekend with this post but it is too important of a topic to ignore. As I have mentioned before Venezuela has a serious, and growing, HIV/AIDS problem. It has an expanding rate of infection and there are far too many likely infections that haven’t even been detected due to lack of testing.

To add to that bleak scenario, from yesterday’s Ultimas Noticias we get even worse news – the treatment of people with HIV is deficient and deteriorating. HIV can be largely controlled using a “cocktail” of various anti-viral drugs. However, it is very important that they be taken in a very prescribed way and time. In Venezuela this is not proving possible as different anti-viral drugs are often unavailable for weeks or even months. For example, U.N. gave an account of a person named Ramon from Valles del Tuy who had to run all over Caracas trying to find his anti-viral medications – to no avail. His treatment includes the drugs Epivir, Videx, and Strocring but he couldn’t locate a supply of them anywhere. He now has gone a week without these medications and already he is starting to feel the ill effects. Further, a month ago he went 32 days without another drug, 3TC.

Even more amazingly, in the entire country there is absolutely no CD4 monitoring tests. This is an extremely important test that monitors the level of anti-viral T-cells in a persons blood stream and by extension determines how strong their immune system is. Without this test medical providers have no way of knowing when to begin which course of treatment. To date the only thing that has prevented complete collapse is that several Non Governmental Organizations have been able to step in and supply many of the drugs the government is supposed to be supplying but isn’t.

All of this is a public health disaster. You simply cannot treat HIV/AIDS part time. By having patients on anti-viral drugs but skipping treatments you allow the virus to become resistant to the anti-viral drugs. Once this happens, you will have HIV that will be untreatable and everyone will be screwed. So these lapses in the availability are completely unacceptable. In fact, once the drug companies become aware of what is happening in Venezuela it is possible they could cut the country off completely to try to avoid drug resistant strains of HIV from developing there.

The question is how is this being allowed to happen? Ultimas Noticias places the blame right at the top with the Minister of Health, Francisco Armada. For example, according to them the shortage of antiretroviral medications results from Armada “forgetting” last month to sign the requisition for them. And amazingly, as of this past Tuesday the requisition had still not been signed.

Something needs to change. Certainly much good public health work has been done in Venezuela. The collaboration with Cuba to give primary care to millions who never previously had access to it has been brilliant. Further, despite heavy odds and outright sabotage from the opposition Venezuela has been successful in bring down its infant mortality rate, increasing the number of people properly vaccinated, and increasing overall life expectancy. The Venezuelan health system can be proud of that.

However, I don’t think they want to become known as the country in the western hemisphere that let HIV/AIDS explode out of control. Yet that is the direction they are clearly headed in. They need a turn of 180 degrees RIGHT NOW. And beyond some heads rolling in the Ministry of Health, which certainly they should, here is a helpful hint. Just as they collaborated with Cuba to improve primary care, something in which Cuba has a lot of expertise, they should collaborate with the Brazilians in combating HIV. Brazil is recognized has possibly having the best public health initiatives against HIV in the world. They have been very successful in limiting its spread in spite of a large drug using community and a large sex trade. So good are they that when the reactionaries who are running the U.S. these days cut of aid to Brazil simply because they wouldn’t denounce prostitution Brazil didn’t bat an eyelid. They simply don’t need any help from the yankees.

So lets get rid of the incompetents in the Ministry of Health and lets bring in the Brazilians and lets do it now.


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