Health warrior from Europe – Antiretrovirals are indispensable – but not a cure
The little guy was just skin and bones when he was brought into the care of HOPE Cape Town. He was just two years old and HIV-positive. His parents had little hope that he’d ever be healthy again. A few months later they were amazed by the effects of antiretroviral therapy. Their mortally ill son had turned into a lively infant who crawled around excitedly, just like any toddler in the world. The parents regained their determination and hope.
On his third birthday we – parents, relatives and I – stood at the boy’s grave. What had happened?
Initially the strong medication had a therapeutic effect on the boy’s system. But then came the night when he suddenly collapsed. The parents had no money to pay for transport, so they carried him on foot. Hours later they arrived at Tygerberg Hospital. Too late. Shortly after they arrived, the child died – and nobody really knows why. The doctors suspect acidosis (too much acid triggering an imbalance in the blood) caused by the drug AZT. That can happen with children, and the reaction requires timely intervention. But the cause of death was to remain the doctors’ best guess; an autopsy would have been much too expensive.
The story of the boy illuminates a neglected feature of the HIV/Aids problem. All the drugs that extend and improve the lives of HIV-positive patients were developed specifically for adults. So far medical scientists have not succeeded in establishing the specific side effects of these medications on infants and toddlers on a long term. Millions of Rands are being spent on research in South Africa to study this phenomenon. The money comes mainly from the United States, and if one wished to be spiteful, one might say that South Africa is like a big research laboratory, with minors as guinea pigs, to determine the effects of medicines on children.
This may be exaggerating matters, but research practices do raise serious ethical questions. At what age should children receive treatment? Is it prudent to expose babies to these heavy-duty drugs? What are the effects of therapy in cases where childcare is inadequate, as often happens in townships for many reasons? There is not a single Church document that deals with such ethical issues. Talk about the great benefits of ARVs is not helpful when there is no effective structure to control their regimen (without which ARV therapy is certain to fail).
And yet most experts invest an unwavering faith in a pharmaceutical solution, always obsessions of modern medicine. They declare war on the virus and send their Aids warriors into battle against the virus. But their weapons – cocktails and condoms –often misfire. Many people see no point or reason in preventative measures. They don’t relate to the Western understanding of hygiene. They take the pills with contaminated water. Then they vomit out the drugs because their undernourished bodies cannot handle them. They take their medications randomly or incorrectly because they live in chaotic conditions. There usually is nobody who can supervise and control the essential discipline. Some patients even sell their medications to make ends meet.
At best, the health warriors can reduce the effects of the pandemic. But they cannot fix the causes of the pandemic – mass poverty, ignorance, and sexual domination. Perhaps one needs to be in Africa to fully understand that here Aids is not a medical but an economic, social and cultural problem. But what alternatives can the health warriors turn to? So they continue to place unconditionally trust in ARVs, as if medical therapy is going to be a miracle cure.
HOPE Cape Town was one of the first organisations in the Western Cape to distribute ARVs – and among the first to warn against their inappropriate use. We did so because the haphazard consumption of Aids drugs can create dangerous viral resistances. When our patients go home to their villages in the Transkei, we are left with piles of medications. But they must take the drugs every day at the same time, for the rest of their lives; if they don’t, drug resistance will end the therapy.
Even people in the Treatment Action Campaign (TAC), South Africa’s most influential Aids activist organisation, see ARVs as the most effective multi-purpose weapon – as if the disease would be defeated if only all patients were taking them. But not all people who are HIV-positive require ARV treatment. And therapy can succeed only if it is carried out with rigorous discipline. Many areas of South Africa lack the conditions for the rigorous regimen demanded by the therapy. There is a lack of clinics, equipment and qualified personnel. So one should be dubious about populist slogans like “Treatment for All”, which raise the hopes of people without the possibility of these ever being met.
Meanwhile studies show that mortality among ARV patients from disordered environments is higher than among those fortunate to have been born into stable circumstances. This shows that medication alone is not a solution: poverty, deficient infrastructure and social conditions are crucial factors in the success or failure of medical treatment.
In light of all this, we have to deal with the epidemic holistically, with an integrated approach. In this field the Church in particular faces a challenge. The HIV/Aids problem calls on the Church to promote its charism of justice and peace in safeguarding God’s creation. The Church should provide leadership in response to this human catastrophe. We, the Catholic Church with its 1,2 billion followers, are a global player with enormous influence. We have a moral obligation to change the face of the earth and to tackle the issue of HIV/Aids constructively. And this global engagement begins with the youngest victims, such as that helpless little fellow whose distressing story I told at the beginning of this chapter.
Gott – Aids – Afrika
Hardcover: 207 pages – Publisher: Kiepenheuer & Witsch GmbH (August 31, 2007)
Language: German – ISBN-10: 3462039253 – ISBN-13: 978-3462039252
Gott – Aids – Afrika
Paperback – Bastei – Luebbe –
Language: German – ISBN-10: 3404606159 – ISBN-13: 978-3404606153