The Executive Director of the Australian MSF says that there should be no queue for antiretroviral therapy in Myanmar. Then their doctors won't have to make any difficult triage decisions. Paul McPhun says the UN says one hundred thousand people need antiretroviral therapy urgently. The [him] moderator is not aware of any UN estimate of one hundred thousand. Can anyone point it out to [him]?
Not a word about prevention in Paul's diatribe.
[him] moderator
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Funding fails unacceptable reality of AIDS in Burma
Paul McPhun
The Australian
July 25, 2011 12:00AM
ON the back of Foreign Minister Kevin Rudd's recent trip to Burma and his visit to a Medecins Sans Frontieres HIV/AIDS clinic in Rangoon, the Australian government announced its assistance had increased in the past year by $18.5 million and was on track to reach $50m by next financial year.
Rudd explained that the Australian government was focused on helping people overcome poverty and on saving lives - truly appropriate objectives in the case of Burma.
What he failed to explain is that, even under the best-case scenarios of aid funding from governments such as Australia, and international finance organisations such as the Global Fund, tens of thousands will still die of AIDS-related illnesses every year for the foreseeable future.
Despite the importance of Australia's contribution to the Three Diseases Fund (from which MSF receives part of its HIV clinic funding) and other international efforts to scale up treatment in Burma, the UN says at least 100,000 people urgently need lifesaving antiretroviral treatment (ART).
Of those, about 30,000 are receiving ART through the Health Ministry and other organisations such as MSF, while an estimated 7000 more are buying ART in private clinics. The rest must simply wait.
Despite the welcome injection of new dollars, the unacceptable reality is that about 15,000 people have been dying in Burma each year. Even with current patient uptake projections, that number will not significantly fall.
We know this because of our medical experience in Burma, where we are forced every day to make impossible choices about who to put on treatment. The reality of rolling out HIV/AIDS treatment in the face of such a large-scale problem is that the lifelong treatment required and the subsequent enrolment of patients are simply beyond our current and future capacities.
MSF provides ART to more than 20,000 patients, and with another 3500 in the process of being enrolled this year we are reaching our limits. We have at times been forced to freeze enrolment and must conduct what is a desperate form of triage.
Our monthly quotas are determined by patient volume versus the quality of care they require for successful treatment - currently, that means 240 new patients a month in our Rangoon clinic.
This forces our doctors daily to withhold ART from patients who, according to World Health Organisation standards, must receive it, but are not as sick as the next person in the queue.
MSF has has been forced to include only the sickest patients - those with a CD4 count (a measure of immunity) less than 100. WHO's minimum is 350. This means too many patients are very sick when they start and too many die before treatment can take effect.
Other patients succumb to opportunistic infections such as meningitis or tuberculosis. Our doctors are frustrated at being unable to provide appropriate treatment, and hate seeing the ones they do treat suffer and die.
No doctor should have to make such decisions. If making a real difference to save lives and improve the quality of life is an Australian desire in its national aid program, more needs to be done.
Paul McPhun is executive director of Medecins Sans Frontieres Australia
http://www.theaustralian.com.au/news/world/funding-fails-unacceptable-reality-of-aids-in-burma/story-e6frg6ux-1226100839368
