Monday, August 11, 2008

Dessert with no dinner

The way HIV/AIDS-related programs are executed in Mozambique often reminds me of the episode of M*A*S*H in which Major Winchester donates gourmet chocolate to the Korean orphanage, only to learn that the head of the orphanage has traded the stuff on the black market for food staples like rice and beans. "Forgive me," he says, when he's realized his mistake. "I have given dessert to children who have had no dinner."

You'll see what I mean when you read this. When the magnitude of the HIV/AIDS epidemic became known, the international community flocked to the aid of affected countries, pouring money into programs for prevention, treatment, and impact mitigation. This is most definitely a good thing: helping sick people, and preventing people from getting sick, is a valid goal, particularly in the case of AIDS, which affects people of the age who otherwise would be earning money for their families and taking care of children.

But whether it's because of these ties to economic development; or because of the threat of AIDS spreading from Africa to our own safe and cozy homelands; or because of the ability of this disease to capture the imaginations and hearts of donors, AIDS has unfairly taken top priority on the international aid agenda. It's not uncommon to visit a hospital in which the beautiful, new areas dedicated to AIDS care sit beside the other wards, which are overcrowded, crumbling, and understaffed. Or, teenagers' curricula on STIs and sexual health, often NGO-run, are fine-tuned based on international best-practices -- but the students have had no adequate preparation in areas like the germ theory of disease or population biology, which are essential to their understanding HIV's transmission and spread through populations.

Or, like in the article linked to above, people with inadequate nutritional intake are given expensive and potent medications to treat their illness. I work in HIV/AIDS research, and I believe that it is indeed an international emergency. But we in the international development, research, and health communities need to ensure that dinner is provided before dessert.

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