If the world responds to a controversial manifesto just issued, sub-Saharan Africa may see a vast array of new clinical trials that aim to determine how best to use anti-HIV drugs in poor, AIDS-ravaged countries. These trials, if they take place, will also try to answer the most troubling unknown of all: How much can anti-HIV drugs help reverse the devastation facing the African subcontinent, which is home to an estimated 24.5 million HIV-infected people?
The richly detailed, 36-page document, entitled "Consensus Statement on Antiretroviral Treatment for AIDS in Poor Countries," was issued on 4 April by 128 Harvard AIDS researchers, clinicians, economists, and experts on Africa. The statement calls for treating 1 million people in sub-Saharan Africa within 3 years, at a cost of $1123 per patient per year, or about $1.1 billion annually. This cost includes $25 million per year to study the impact of the intervention on a staggering 50,000 people. By 5 years, they hope to offer treatments to 3 million people. Harvard economist Jeffrey Sachs, who led the writing of the statement, explained that they went to great lengths to address the perceived obstacles to this plan, including the perception that such a program might harm prevention efforts, lead to wide-scale drug resistance, and fail because of infrastructure problems.
Outside of Harvard, some leading funders of AIDS efforts in Africa have raised serious concerns about the plan. In a joint press conference, Bill Gates Jr. (whose foundation has devoted hundreds of millions of dollars to combating the epidemic in Africa), United Nations Foundation President Tim Wirth, and Rockefeller Foundation President Gordon Conway cautioned that the public debate has been so focused on providing treatment that the plan will inevitably divert resources and efforts that otherwise would have gone toward prevention.
AIDS immunologist Bruce Walker of Harvard Medical School acknowledged that even if this plan receives funding and treatment becomes widely available in Africa, it will not end the epidemic: The drugs, after all, are not curative, and many cause serious side effects. "Even under the best circumstances, we're not going to convert this from a catastrophe to a noncatastrophe," said Walker. "But for God's sake, let's try to minimize this as much as we can."