While HIV is indeed an important disease it has totally devastated our health system! Single issue NGO’s and INGO’s have taken over government policy in health! Together with our corrupt officials training, education, research and primary as well as tertiary health care have been taken over by HIV and HIV related issues!
Take an example of our generation. I would love to do a survey on where everyone is. My anecdotal experience is that everyone who is not working in some sort of HIV clinic or organisation is managing some sort of HIV donor funded project. even those people who have managed to do some work outside HIV have only managed to do that by accessing HIV funds.
My mentor is one perfect example. Brilliant in his own field, his workload, travel and research committments have over the years been taken over by his HIV work untill he resigned to head an HIV research organisation! He is not the only one. You and I can nominate a list of people in yours and my fields whose primary and full time occupation is managing or spending HIV donor funds! For many years my mentor could only finance his patients treatment by tying his work to HIV donor interests -and he is not the only one.
There is so much duplication of HIV related work in Mulago that it beggars belief how they each find space!They are all falling all over each other to find a space on the hill to carry their banner! But then you know the answer -many are there not to treat HIV patients but to generate research, to access large number of patients in the shortest time possible, to accelerate the access of new molecules from benchtop to the clinic, to access a more friendly ethics board, to accelerate their own tenure by publishing for the sake of publishing, to fulfil ‘corporate responsibility” while advertising with cheaper dollars (one gets more advertising mileage and exposure per dollar spent out of “adopting” an AIDS orphan, “donating” to HIV victims in the third world). The only advertising that comes cheaper is a nipple slip or a “wardrobe malfunction or better still a soft porn video released on the net by a former boyfriend -all orchestrated by a PR firm!!!
There is no doubt that there are individuals who have benefited from the donor gold rush! But is this really the best way of offering treatment to HIV patients? in a country where primary health care physicians (as in GP’s given there is no GP training programme) do not exist and no formal training program exists for them, who looks after these patients after they leave the rarefied air conditioned day units run by JHU, MRC, UCLA, CWRU, McMasters, Baylor etc! just across from the sparkling units are the pathetic general medicine and surgical wards where the same patients will have to sleep on the floor, the paediatric emergency unit where the babies share small tubes of oxygen nevermind the infectious diesease implications. Pretty much every specialist unit that cannot somehow relate its activities to HIV is falling apart as donors are only interested in a single issue!
In a country where 100,000 children die of malaria a year, dont we need to re-examine our priorities?
The president will not have treatment or even basic checkups in the hospitals of the country he has led for 23 years. Neither are any of his grandchildren born in the country -their mothers have to be flown out of the country at great cost to do what animals do naturally al the time -have normal deliveries!
There is no doubt that corruption in Uganda has been fueled by the “AIDS industry”! You can rest assured that the USD in Uganda is supported by HIV money inflows and many a mansion in Uganda is bought or built on donor HIV funds. Ditto many fortunes are based on HIV funds! Next to starting a church, starting an HIV NGO is the equivalent of opening a bank! Except that n this particular model of business (HIV business) you d not have to show any profits. Each financial year start off with funds for you to spend. And woe betide you if you fail to spend them as next year the donors will cut the figures! It is a growth industry -you have to increase your share of the available funds each year, meet your targets, come up with more fancy ways.
this is not about finding simple solutions. it is about finding the most complexsolutions to the simplest solutions. The more workshops, the more per diem. The more working parties, the more sitting allowance, the more travel to “consult”, the bigger the 4WD and out of office allowances, as well as conference allowances and trips to shop in geneva and New York while consulting “donors”!
Somewhere along the way one starts to ask -do the drivers really want to get anywhere? Or is this a never ending journey that we should all just sit back and relax for? Do we really want cures or do we just want more and fancier medicines -the more expensive the better?
I have always wondered. If small pox had been around in these times whether we would have ever been able to eradicate it!!! Would the vaccine have been available to the masses or would it have been commercialised with as much time and money spent on protecting the companies intellectual property as in eradicating the virus. CAn we really eradicate malaria or is it not desirable!
Do we really want to eradicate HIV or is it just too sexy as an accessory to our lifestyles?