Fight Against AIDS: Small Triumphs, Sunny Optimism and Grim Reality

Commentary in the NYTimes August 15, “Fight Against AIDS: Small Triumphs, Sunny Optimism and Grim Reality”

With our 10-year head start in
disbursing AIDS drugs [in the United States], we have learned many times over that the drugs
are just the beginning. Once they are bought and dispensed, the work
only gets harder. Side effects and failures are just part of it.
Eventually, inevitably, you have to deal with … the health care system itself.

AIDS drugs demand an
infrastructure. It has taken this country almost 20 years to cobble the
first layer together: a network of people trained to administer drugs
and watch for problems. At its best now, in states like New York, it
functions like a smooth machine, delivering freely available
medications, all the necessary tests and probably some of the best,
most comprehensive AIDS care in the world.

you start taking care of people, there is no end. It takes a real
health care system to treat even a single illness…

they [ARVs] do is let people live long enough to need everything else — TB
drugs and decongestants, insulin and hemorrhoid creams, cardiac
catheterizations and hip replacements, mosquito netting, malaria pills and polio
vaccines. Idealists would point out that food and water, housing, jobs,
autonomy and civil rights should probably head that list.

Can Mr. Gates’s billions really begin to pay for a new world?

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