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Press Release 
JUNE 20, 2001
 
SHAME ON MR. NATSIOS, ADMINISTRATOR OF 
THE U.S. AGENCY FOR INTERNATIONAL DEVELOPMENT
 
WASHINGTON, D.C. – It is a disgrace that a high ranking U.S. government official is still collecting taxpayer dollars after making disparaging, discriminatory, and inaccurate comments about the people of Africa who are suffering from the ravages of HIV/AIDS.  President Bush should dismiss Andrew Natsios, the new Administrator of the U.S. Agency for International Development at once.

Instead of offering the United States’ assistance to help the infected people of Africa receive the treatment they desperately need,  Mr. Natsios stated that our efforts will not work because Africans “don’t know what Western time is,” and thus cannot take drugs at proper times.  He went on to say that if you ask Africans to take medicine at a certain time, they “do not know what you are talking about.”  How disgraceful.  The Administrator of our nation’s lead agency for international development and assistance should educate himself about AIDS treatment and about the peoples of the world before he reveals astonishing ignorance as well as prejudice. It’s time for Mr. Natsios to go and for the Bush Administration to instead appoint a real leader who will bring honor back to this distinguished agency.

Below is an op-ed, which appeared in the Washington Post on Friday, June 15, 2001 by Amir Attaran, Dr. Kenneth A. Freedberg, and Martin Hirsch, respected experts in the field of AIDS research and international development.  They comment on Mr. Natsios’ remarks and proposed plans for U.S. funding and involvement in Africa and they make a very persuasive case for his immediate dismissal.

The Washington Post 
June 15, 2001, Friday
Dead Wrong On AIDS 

Andrew Natsios, the Bush administration's new chief of the U.S. Agency for International Development (USAID), has made a very bad start with regard to one of his agency's primary missions: dealing with the scourge of AIDS in Africa. Natsios has made comments recently on the prevention and treatment of the disease in Africa that are, to say the least, disturbing, if not alarming. 

His comments appeared last week in the Boston Globe and in testimony before the House International Relations Committee. On both occasions he argued strenuously against giving antiretroviral drug treatment (the AIDS treatment used in the United States today) to the 25 million Africans infected with HIV. 

Although Natsios agrees that AIDS is "decimating entire societies," when it comes to treating Africans, he says that USAID just "cannot get it done." As Natsios sees it, the problem lies not with his agency but with African AIDS patients themselves, who "don't know what Western time is" and thus cannot take antiretroviral drugs on the proper schedule. Ask Africans to take their drugs at a certain time of day, said Natsios, and they "do not know what you are talking about." 

In short, he argues that there is not a great deal the agency he leads can do to help HIV-positive Africans. Under his guidance, USAID will not offer antiretroviral treatment but will emphasize "abstinence, faithfulness and the use of condoms" as the essence of HIV prevention. (He also supports distribution of a drug that blocks transmission of the disease from mother to child, and drugs to fight secondary infections.) While this might save some of those not yet infected with the virus, it in effect would condemn 25 million people to death, and their children to orphanhood. 

As the administration's man in charge of international assistance, including helping Africans with AIDS, Natsios should know better. His views on AIDS are incorrect and fly in the face of years of detailed clinical experience. 

Take the issue of whether AIDS should be dealt with by prevention or treatment. In backing prevention to the total exclusion of treatment, Natsios favors only modest changes in the strategies that USAID has relied on for the past 15 years, which by themselves have clearly failed to stem the pandemic. This is why expert consensus now agrees that prevention and treatment are inseparable -- or, in the authoritative words of the UNAIDS expert committee, "their effectiveness is immeasurably increased when they are used together." 

The same conclusion has been reached by countless other experts, including 140 Harvard faculty members who recently published a blueprint of how antiretroviral treatment could be accomplished. Harvard physicians are now treating patients in Haiti, and others are achieving similar treatment successes in Cote d'Ivoire, Senegal and Uganda. 

It is also disturbing that Natsios chooses to exaggerate the difficulties of AIDS treatment, as if to single-handedly prove it would be impossible throughout Africa. Whether Africans can tell "Western time" or not is irrelevant; nearly all antiretroviral drugs are taken only twice a day -- morning and evening. Sunrise and sunset are just as good as a watch in these circumstances. Nor is Natsios correct when he says the drugs have to be "kept frozen and all that." Not a single antiretroviral drug on the market today needs freezing. In fact, some bear warnings not to freeze them. 

Natsios also said that "the problem with [delivering] antiretrovirals . . . is that there are no roads, or the roads are so poor." In fact, millions of AIDS patients live in cities such as Cape Town, Dakar or Lagos, where the streets are teeming with cars. 

Natsios says that antiretroviral drugs are "extremely toxic," so that as many as "forty percent of people . . . who are HIV positive do not take the drugs . . . because they get so sick from the drugs that they cannot survive." This is a view shared by no one in the medical establishment today. Clinical and epidemiological studies by the Centers for Disease Control and the National Institutes of Health have shown that these drugs are safe for most people and prolong life by many years. 

Two facts are clear. 

The first is that, in Abidjan and Johannesburg, as in Manhattan, AIDS prevention and treatment must go hand in hand. And we can accomplish this if the Bush administration contributes adequately to an international trust fund for that purpose (it has so far promised only $ 200 million, or just 72 cents per American). 

The second fact is that Andrew Natsios, by virtue of his unwillingness to acknowledge the first fact and his willingness to distort the true situation in Africa before Congress, is unfit to lead USAID and should resign. 

Amir Attaran is director for international health research at Harvard University's Center for International Development. Kenneth A. Freedberg is a physician at Massachusetts General Hospital and an associate professor at Harvard Medical School. Martin Hirsch is director of clinical AIDS research at Massachusetts General Hospital and a professor at Harvard Medical School. 

 
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