Sir, - The Geneva AIDS conference showed that two decades into the AIDS epidemic - which rivals the Black Plague - infection rates are still rising. Over 33 million people are now infected. Child mortality rates in Africa are expected to double in five years due to the spread of AIDS, offsetting all gains in child survival since the 1950s. The reason public health efforts have failed to control the epidemic is that the role of poverty in the spread of AIDS has been overlooked in favour of medical and scientific research. As a result, affluent countries, with a small minority of the world's AIDS patients, now have treatments and care available. However, over 90 per cent of infected people live in developing countries, where 800 million people do not even have access to clean water, much less health care.
The real answer to the AIDS problem is to focus on the preconditions to basic human well-being. The United Nations has calculated that for $35-40 billion per year, "basic social services" could be provided for all the poorest people on the planet. This includes primary schooling ($3-6 billion), basic health care and nutrition ($11-13 billion), reproductive health and family planning ($11-12 billion), and low-cost clean water and sanitation ($5-6 billion).
Meanwhile, we have spent billions on AIDS research and treatments. According to one estimate, making the standard AIDS treatment available worldwide would cost $36.5 billion. In other words, the total budget needed to provide "basic social services" for all could be consumed just treating AIDS alone, and it would still not address the underlying social causes of the spiralling growth of the epidemic.
Clearly, real progress in stopping the spread of AIDS will require a global attack on absolute poverty. This is achievable, but will only happen if we approach AIDS with a new anti-poverty mindset and a change in spending priorities, and political will.
Blaise Salmon,
Vancouver, Canada.