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Experts Say AIDS and Hunger Increasing Threat to Africa - 2004-05-20

Experts have told the U.S. Senate that AIDS and hunger in sub-Saharan Africa are making each other worse. The testimony before the Foreign Relations Committee comes as the World Health Organization (WHO) releases its 2004 World Health Report.

The World Health Organization says an estimated six million people will die of AIDS soon unless they receive treatment, but treatment is reaching less than one-tenth of them. In its 2004 World Health Report (released May 11), the WHO says AIDS is the biggest public health challenge facing the world today, but the report also notes that the international community is focusing more attention and political will on the disease than ever before. Executive Director Richard Feachem of the Global Fund to fight AIDS, Tuberculosis and Malaria said that there's more good news.

"Availability of finance is no longer the binding constraint in doing what we need to do around the world. Large amounts of new finance are available," he said. "And the cost of the drugs is no longer the binding constraint. Fixed dose combinations of anti-retroviral drugs are now available for prices of around $150 a year. Which is an extreme reduction as compared to a few years ago."

The WHO has launched a plan to make AIDS drugs available to three million people by 2005. Experts say money spent on improving access to AIDS treatment in the developing world will also help improve health care systems overall.

However, when AIDS relief workers in Africa ask many villagers what they need most, Executive Director James Morris of the U.N. World Food Program says drugs are not at the top of the list. "The first thing they ask for is food," he said.

Mr. Morris told the U.S. Senate Foreign Relations Committee that the AIDS epidemic is creating a downward spiral of hunger and disease in Africa. Of the more than 40 million people worldwide with HIV, some two-thirds of them are living in poverty in sub-Saharan Africa. More than seven million farm workers in the region have died of AIDS so far, and another 16 million are expected to die by 2020. Fewer farmers means less food and Mr. Morris says the loss of those farmers often means children and the elderly have to take over.

"The seven million lives that have been lost in agriculture or the two-plus-million that were lost last year, are the most productive people," he noted. "You will see a grandmother in her 70s, very slight, often looking after 20 or 30 children and she has nothing."

U.S. Global AIDS coordinator Randall Tobias told the committee that those living with AIDS are often too weak to plant and tend enough crops. Families of people with AIDS are often forced to sell livestock to pay for food, medicine or even funerals. That makes their food supply even less secure. What's worse, malnutrition weakens the immune system, making people with AIDS more vulnerable to opportunistic infections and Mr. Tobias added that AIDS drugs don't work as well when patients are hungry.

"Without access to safe and adequate food, people are less able to effectively respond to AIDS treatment," he said. "Moreover, drug resistance grows if people fail to stay with their treatment regimens. Persons living with HIV/AIDS, but without access to sufficient food have less time to focus on care and they pay less attention to issues of prevention."

Mr. Tobias also noted that people fleeing food crises can spread HIV. It is a vicious cycle: hunger worsens AIDS, and AIDS worsens hunger and it's part of the reason that the WHO's new report says the epidemic threatens parts of sub-Saharan Africa with economic collapse. So the World Food Program's Mr. Morris says it's essential to coordinate AIDS relief and prevention programs with hunger relief and prevention programs.

"Everyone understands it takes all the ingredients to get at this," he added. "No one approach will solve the problem."

Mr. Morris says private donors, government agencies and non-governmental organizations are all working together to relieve the twin epidemics of AIDS and hunger.