East Meets Westwood
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Brazil has managed to cut its AIDS mortality rate in half over
the last 10 years, in part by ensuring that all those infected
with HIV have access to free anti-retroviral medicines. The strategy
was made possible by a controversial law that allows the government
to produce generic copies of imported drugs in case of a national
emergency. Today, the government produces eight of the 15 drugs
in the cocktail and has negotiated discounts of up to 70 percent
for the others by putting pressure on international drug companies.
The innovative strategy has turned Brazil into a leading example
in the fight against AIDS.
Other countries, including the Asian nations that
collaborate with the UCLA/Fogarty program, have struggled. So-called
highly active anti-retroviral therapy (HAART), while potentially
lifesaving, requires a complicated medication-taking regimen and
financial wherewithal, both of which continue to serve as significant
barriers in much of the developing world. Even as the cost of
HAART comes down and countries begin to produce the drugs themselves,
the infrastructure for identifying people in need of treatment
and effectively managing patients through the complex therapy
is often severely lacking.
"Treatment is becoming increasingly available
in these countries, but if you don’t know who is infected,
you can’t provide it," says Detels. He notes that
the majority of HIV-infected individuals in Asia are unaware that
they’re infected, which makes them less likely to reduce
their risky behavior. "Unfortunately, the stigma attached
to being identified as HIV-positive — or merely getting
tested — continues to be so terrible that a lot of people
must decide whether doing so is worth the risk of losing their
job and being alienated from their family and community,"
Detels explains. With that in mind, several UCLA/Fogarty trainees
are undertaking projects to identify factors associated with stigmatization
among health-care workers and villagers.