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AIDS CARE IN AFRICA

April 19, 2001


Session on
"The Promise of Research in Accelerating AIDS Care in Africa"
Remarks by
Anthony S. Fauci, M.D.
Director National Institute of Allergy and Infectious Diseases
National Institutes of Health
Bethesda, MD

Kampala, Uganda


Ladies and gentlemen, friends and colleagues:

It is a distinct pleasure and an honor for me to be here at this important event, a gathering that takes place at a critical time in the evolution of the global response to the HIV/AIDS pandemic. We are experiencing a most extraordinary work in progress; indeed, we are moving in uncharted territory.

Up until the past few months, there was a long-held assumption that a comprehensive approach to the prevention of HIV infection and the treatment and adequate care of HIV-infected individuals throughout Africa was beyond the realm of possibility. We are gathered here to state -- emphatically -- that this is not the case, and to work together toward a number of important goals, including:

Building the capacity in the African context to effectively treat HIV disease and prevent HIV infection;

  • Expanding African AIDS prevention programs and integrating them with provision of care;
  • and, the specific focus of this session:
  • Building research infrastructure and leadership in Africa to improve HIV care and prevention on this continent in ethical and equitable ways.

For certain, what we wish to accomplish and sustain in the complementary realms of HIV treatment and prevention will not be easy tasks even under the best of circumstances. There are social, ethical, financial, political and other considerations that loom large in the face of any attempt to provide Africans with the care that they, as citizens of the world, deserve in the midst of this devastating pandemic. Furthermore, the infrastructure necessary to implement such programs is minimal, if not absent in many of the hardest-hit areas. We gather here in Kampala in an attempt to begin to address these issues.

It is important to emphasize that when we talk about addressing antiretroviral therapy for HIV/AIDS, we must do so in the broader context of addressing fundamental health care in general. This includes prevention of HIV infection, which I will address further in a moment; treatment and prophylaxis of AIDS-related illnesses; and importantly, other disease killers of Africans such as malaria, TB, and respiratory and diarrheal diseases. The realization of the need to treat HIV has triggered a tidal wave of interest and activity. Let us use this momentum to begin to address a more comprehensive approach to basic health care in Africa as we proceed with the antiretroviral agenda.

I am here for three main reasons and I will keep my remarks brief and to the point. First, I am enthusiastic about being an active participant in the dynamic process that will occur here in Kampala over the next two days and hopefully well beyond this meeting throughout Africa. Second, I am here to exhort us all to insure, in the process of attempting to explore ways to best provide treatment and other forms of care for HIV-infected Africans, that we gather important information that will be critical to the success of this program for Africans, both in the short and especially in the long run. Sustainability is the critical issue here. Third, as I will discuss in a moment, I hope to share some of what the National Institutes of Health (NIH) has learned from our efforts in international health research, and suggest avenues for further collaborations with our African colleagues.

There are many important research questions that need to be asked and answered in the context of the delivery of care, including antiretroviral drugs, to Africans. This slide lists merely a few of these questions.

On another note, there have been understandable and often justifiable concerns regarding research on HIV therapeutics in developing nations where such therapy is not readily available to the population at large. In such situations, the research generally antedates the distribution of drugs. Obvious ethical issues arise with regard to the ultimate long-term benefit to the participants of such research protocols as well as to the availability of drugs to the people of the host nations after the research project has been completed. In the currently evolving setting, it appears that in certain situations the drugs will be made available to infected individuals before the conduct and completion of research that fully determines feasibility, risk-benefit, long-term efficacy, among other important questions. In other words, in certain African countries treatment may be administered regardless of whether research is performed to answer important questions that will inform sustainable strategies. In this regard, because of the emergent nature of the AIDS problem in Africa, just as it is important to make these drugs available to Africans as soon as possible without waiting for the completion of research studies that might take years, so too is it important to gather information in the context of research protocols that are executed in parallel with the distribution of therapies. We cannot be part of a program that merely parachutes drugs into a nation and then imagine that our responsibility is over. We must be part of a process that ensures sustainable, successful outcomes.

In addition, it is critical to link therapy with prevention efforts. Attempts at pursuing prevention efforts have often been hampered by the fact that little, if anything, could be offered to the HIV-infected individuals who were the subjects of such prevention efforts. Now that it appears that treatment may be available for progressively larger numbers of Africans, it would be a major mistake not to link closely treatment with prevention. We will have a unique opportunity to accomplish synergistically two goals within a single effort. There is an additional issue with regard to prevention.

There is an understandable concern among some that the prevention agenda, including the development and testing of vaccines aimed at people who are not infected, will be minimized in the setting of the tidal wave of interest in a treatment agenda for those who are infected.

We cannot let this happen. Both agendas are critical and indeed are complementary as indicated by this recent newspaper headline.

Finally, let me address the third reason why I am here. The United States National Institutes of Health (NIH), in particular the National Institute of Allergy and Infectious Diseases which I direct, for many years has been involved in research, and the building of research infrastructure in developing nations, including sub-Saharan Africa.  With regard to international HIV/AIDS, the total NIH effort has accelerated greatly in recent years.

We have for many years supported researchers who have developed active partnerships with African investigators and institutions; pictured here are the more than 100 NIH AIDS-related projects, including research, training, and other activities in 30 African countries.

Among these efforts are the HIV Prevention Trials Network (HPTN) and the HIV Vaccine Trials Network (HVTN).

I am pleased to note that Uganda hosts 2 HPTN sites, a state-of-the-art immunology laboratory as well as the internationally known Rakai Project, which is studying the interaction between HIV/AIDS and sexually transmitted diseases. In addition, not shown on this slide, the NIAID Tuberculosis Research Unit (TBRU) managed by Case Western Reserve University has been very active in Uganda and will work very closely with the HPTN and other NIAID-funded projects in Uganda.

In areas other than HIV/AIDS, NIH supports projects in tropical and emerging infectious diseases -- such as TB and malaria -- throughout Africa. Of particular note are the International Centers for Tropical Disease Research (ICTDR) that are pictured on this slide .

In addition, our international programs emphasize the importance of developing "centers of excellence", which are partnerships with developing countries focused on critical health problems such as HIV/AIDS.

An example of such a Center that I often use as a model for future efforts is NIAID's Malaria Research and Training Center in Bamako, Mali.

The center in Bamako is recognized as one of the top malaria research organizations in Africa. It is a truly African facility: the research there is planned, directed and executed by African scientists, who advise the malaria control program in Mali and train personnel. The factors in the success of the program are delineated in this slide; I would highlight the importance of a long-term commitment to the success of this program.

We are willing and eager to continue and expand our commitment to international research. However, we obviously cannot do it all. Clearly, research is only a part, and likely a relatively small part, of the required broader and more comprehensive approach to the AIDS pandemic in Africa. Success of the latter will require a sustained team effort comprised of governments of host countries and developed nations, WHO, UNAIDS, the World Bank, industry, NGOs, philanthropic organizations and many others.

I promise you that the National Institutes of Health of the United States within the framework of its resources and within its areas of expertise will do its very best to be an active member of this team.

Finally, let us not expend our energies searching for a variety of reasons why we should not act and why this effort might fail; rather let us apply ourselves as a team to the task of developing sustainable efforts that will assure success. I look forward to participating actively in this meeting and learning more about how we can be strong partners in this historic process.


NIAID conducts and supports research—at NIH, throughout the United States, and worldwide—to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at www.niaid.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

NIH...Turning Discovery Into Health ®

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Last Updated April 20, 2000