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Rapid Responses: Rapid Responses published:
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More on Rawls
- Roger L. Albin (25 January 2002)
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Much needed reminder on HIV/AIDS
- Lombe Kasonde (1 February 2002)
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why is AIDS so bad in Africa?
- Dorothy Elizabeth Logie (3 February 2002)
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vaccines for HIV
- Sydney J Lachman, Prof Max Price (6 February 2002)
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The Global Fund: Raising the Stakes
- Anders Nordstrom (11 February 2002)
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Roger L. Albin, Professor of Neurology University of Michigan, Ann Arbor, MI, USA, 48109
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It is not exactly correct to say that Rawls argued that justice is required when resources are scarce and life is brief. Rawls' argument is much more comprehensive and powerful. In Rawls' system, justice is required under any circumstances. More pertinent to the HIV/AIDS pandemic, Rawls insists on the use of the 'difference principle'. In a Rawlsian just society, inequalities exist but they must rebound to the advantage of the less fortunate. |
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Lombe Kasonde, Pharmaceuticals consultant UNICEF Supply Division, DK-2100 Copenhagen, Denmark
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Dear Authors, Thank you for your recent BMJ article. It was perfectly written, very inspiring and has surely left questions on people's minds that they will hopefully seek to answer. We are working on the update of the inter - agency publication, "Sources and prices of selected drugs and diagnostics for people living with HIV/AIDS" (see http://www.supply.unicef.dk/insideSD/hivaids.htm )in the hope that people requiring these drugs will see that there are more sources of drugs available than the public is lead to believe. Lombe Kasonde, Denmark |
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Dorothy Elizabeth Logie, Public Health, Borders Health Board Melrose TD6 9DB
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Editor, The BMJ is to be congratulated for the quality of the articles in the HIV/AIDS issue (January 26 2002). I hope they will help break the silence and raise awareness of the epidemic which has become a medical, social and economic disaster for Africa. Many sub-Saharan African governments’ fear that their countries will slip into anarchy as so many of the professional classes, health workers, educators, military, die. There was however something missing from the BMJ’s debate on AIDS: the fact that health is fragile and determined less by health services than by the relative fairness of social and economic structures. Sub- Saharan Africa contains 10% of the world’s population and bears 70% of the global burden of HIV/AIDS. It also exists on 1% of the global economy and, with the recent economic slump, this figure is falling. Last week, Zambia heard that the mining group, AngloAmerican, is pulling out of copper production (which accounts for 75% of the country’s export earnings). The mines are likely to close in the next 12 months, putting 9500 miners and 1,600 other workers out of work. These men will migrate in search of new work, one of the many social factors contributing to the epidemic. It is in poor countries with rising unemployment and declining health and educational services that HIV has gained the biggest foothold. Over the last 20 years the World Bank and the IMF have conducted a massive social experiment in poor African countries, called structural adjustment, which has encouraged privatisation of industry, like Zambia’s copper mines, increased unemployment, cut food subsidies and introduced charges for health and education. The structural adjustment ideology has been recently been repackaged and renamed Poverty Reduction Strategy and Programmes (PRSPs) with the intention of giving country ownership of poverty reduction. However the basic macroeconomic programme is not for discussion. Africa urgently needs a realistic evaluation of the continuing effects of debt and neo-liberal economic prescriptions on the health of its people. It also needs increased aid. The Global Fund for AIDS, TB and malaria must be supported by new money: the UK’s pledge of £75 million is to be taken from money already earmarked for aid. The money must be used to boost health services as a whole. AIDS will not be controlled in the long term by anti-retroviral drugs, or even by a vaccine, without examination of the wider social, political and economic factors, which create disease and conditions of risk. |
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Sydney J Lachman, Hon Lecturer Dept Health Sciences Wits University, Prof Max Price
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Dear Sir, I have read the electronic BMJ of 26 January 2002 but do not agree that a vaccine will be developed in the time the various authors state. Even Prof Andrew McMichael of Oxford and other workers doubt this time frame. For your information I predicted the present position in South Africa in1991 in my 4th book, ten years ago. It was reviewed in the NEJM on March 26 1992, Vol 326:13 by Dr Andrew Wiesenthal, then of Denver, Colorado who was influenced by Michael Fumento’s ideas of the homosexual nature of the disease at that time. Way back in 1991 I wrote my 4th book entitled `THE EMERGENT REALITY of Heterosexual HIV/AIDS’. This was sponsored by Messrs. Lennon’s Ltd and at that time did not evoke the attention that history has proved painfully correct in South Africa and developing countries elsewhere. It was then regarded as a homosexual disease and could affect only a small proportion of the world’s population. I fact the homophobia then prevalent was initially responsible for the lack of progress in this field. Political opinion was then a vital factor against its acceptance, as it is now even in the highest quarters in South Africa. I kept on researching the subject and in 1995 I wrote my 5th book `Heterosexual HIV/AIDS as a Global Problem’. This was supported by donations from Glaxo Wellcome and the then Minister of Health Dr Nkosozana Dhlamini Zuma!! (before the Sarafina debacle). A patient Mr Bryan Zylstra provided R140 000 for my 6th book by a donation to the Witwatersrand University Foundation and this was published through the Department of Medicine and I was made an honorary lecturer in that department. The book was entitled `Heterosexual HIV/AIDS as a Global Problem; towards 2000,’ and was published by the Pharmaceutical Society of South Africa. The 7th book of 723 A4 Pages followed in1999, sponsored by Roche Pharmaceuticals, The Skye Foundation and the Brizyl Foundation; both of the latter sell shoes among other things and have no relation to drugs in their business!!! It was entitled `A Knowledge Base of Heterosexual HIV/AIDS’ and is still being asked for by doctors 26 months after publication and is out of print. It was advertised by the Medical Association of South Africa in its 2001Guide to Fees chargeable by Doctors. This has a circulation of about 16 000 doctors. I have always not had royalties from any of these books. Due to lack of sponsors my 8th and 9th books are on the internet where anyone can read them for free. The url is www.pharmnet.co.za/pssa. You may access them at this website provided by the Pharmaceutical Society of South Africa. It is my view that the HIV/AIDS is set to decimate the world’s population and this is not merely dividing by ten as the term usually implies. A teacher wrote to me recently (as her former doctor) telling of 8 black teachers who died of AIDS-related diseases in her school in North West Province in November 2000, and the figures published in Johannesburg Star states that 25% of graduates and a similar number of teachers are currently infected with HIV! Prof Kadar Asmal (Minister of Education) has since queried these figures for teachers. Total of SA people living with HIV is estimated of 4.7 million. I bring these facts to your notice, as these are my experiences over the last 15 years. I delivered a male child in 1960 and he died of AIDS in 1988 so that I am one of the few doctors world-wide who have looked after a patient from cradle to grave!! The busy doctor is confronted with a patient usually in a clinic or in his practice for the first time. With kind regards, I am, Yours sincerely. Sydney J Lachman M.Sc., MB. B.Ch., MRCGP. 43 Bristol Road. Parkwood, South Africa 2193 Phone 27 11 447 2255, Fax 27 11 788 6009. January 31 2002 |
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Anders Nordstrom, Executive Director, Interim Secretariat, The Global Fund to fight AIDS, TB and Malaria The Global Fund to Fight AIDS, TB and Malaria, 9 Rue Varembe, CH - 1202 Geneva
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In its 26 January issue, the BMJ published a letter from Gavin Yamey and William W. Rankin, entitled "AIDS and global justice.” The letter, which refers to the Global Fund to Fight AIDS, Tuberculosis and Malaria, made many points with which we agree, but also missed some important facts about the Global Fund. In a period of approximately one year, the Global Fund has evolved from an idea into a reality. The Fund has raised US$1.9 billion to date, and will soon provide hundreds of millions of dollars to innovative country level programmes serving people living with, affected by, and at risk for HIV/AIDS, tuberculosis and malaria. This is only a start. However the Fund will never be sufficient on its own to address these three health problems, which cause 10% of the world’s deaths and untold human, developmental and economic damage. That will take a long-term commitment on the part of developed and developing nations alike. The Fund was never envisioned as the sole source of financial support for efforts to combat these diseases, but as a new tool to attract, manage and disburse resources beyond what is already being spent. Projected global spending on AIDS, TB and malaria for 2002 stands at approximately US$ 1.6 billion without the Global Fund. The addition of the Fund’s expected contribution of US$ 800 million will actually raise spending on these three diseases by 50%. As for its governance and decision-making, the Fund completed its first board meeting on January 28-29, and is moving to making its resources available to programmes in the most severely affected countries as quickly as possible. The philosophy of the Fund is that prevention and care are inseparable, and both treatment and prevention will both be funding priorities. A request for proposals has already been issued, and the first round of funds will be announced in April. The principles of accountability and action that are central to the Global Fund are reflected in the transparency of its processes. The Fund operations, including the proposal review process and disbursement mechanism, were openly discussed and approved by the Board of Directors at the January meeting. The Fund's decisions will be country-driven, with decisions on proposals for submission to be made at the country level. An independent Technical Review Panel is being established to review proposals and make funding recommendations to the Board. The guidelines for proposals are available on the Fund's website (http://www.globalfundatm.org). The Global Fund is an independent, public-private partnership, and our board includes donor and recipient country governments, multilateral agencies, NGOs, private sector representatives, and representatives from the communities affected by the three diseases. The full involvement of each of these stakeholders represents an unprecedented level of shared commitment to address these epidemics. The BMJ letter incorrectly asserted that a member of the pharmaceutical industry sits on the board of the Fund in a voting position. In fact, the private sector representative on the Board is Mr Goran Lindahl of Anglo American plc, who is also Special Advisor to the UN Secretary-General on the Global Compact. Anders Nordström
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