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. |