---

| A Traveling Physician's View | Ways to Provide Relief | What Happens to the Kids? |

    We in the United States may have a false sense of comfort
from some recent successes in the battle against AIDS. Modern drug treatments such as the AIDS "cocktail" can allow people who are HIV-positive or who have developed AIDS to coexist with the disease. Still, the battle here is far from over, especially among minority populations. And in Africa the battle is unrelenting. There are 11 million AIDS orphans in Sub-Saharan Africa.

The result of a recent reawakening of concern over the AIDS epidemic has prompted calls for a major international effort to find a cure. Meanwhile, I want to offer some cost-effective approaches that could have an immediate impact.

A Traveling Physician's View

I first became aware of the AIDS epidemic while serving as a state legislator. We began to try to combat AIDS through public-education programs. But my real experience with this devastating disease came when I left politics to become a traveling physician and psychiatrist for the US State Department in Africa. Although my assignment was to treat American government employees, every time I walked into a hospital in Kinshasa or Lusaka I'd see rows of patients on the floor in ward after ward.

In one visit to Johannesburg, South Africa, I saw how the disease traveled down the truck routes. Workers from Zimbabwe and Malawi would be brought to South Africa to work in the mines. The mine owners would spend time and money training them to operate heavy equipment. Then, a few months later, they'd be dead of AIDS, having brought the disease with them.

Unfortunately, I could not do much about this in Congress. At the time, South Africa still had an all-White apartheid government, and the US Congress was too invested in sanctions against that government to allow even medical assistance for South Africa.

Now 33 million people are infected with the HIV virus. About two-thirds of the cases are in Africa alone, including 90 percent of the new HIV infections. South Africa now has the highest rate of new HIV infections in the world. About 12 million Africans have died from the disease—10 times as many as have died from wars in the same time period.

Ways To Provide Relief

Recently, Vice President Al Gore said at a meeting of the UN Security Council that Congress will be asked to allocate $100 million for AIDS treatment and prevention programs and $50 million for research on a vaccine. President Clinton made the same promise in his State-of-the-Union address. I applaud the high profile this issue is being given. But my involvement with the epidemic suggests that, until we begin to support community-based responses to HIV and AIDS, the death march will continue.

The following suggestions won't lead immediately to a cure, but they could provide significant relief. First, education and prevention have always been the most effective weapons in halting the spread of AIDS. That means getting people to use condoms. We need to support a program of mass distribution through churches and other community organizations in Africa. Second, we should provide medicine for nursing mothers. Usually, babies born to women with AIDS do not have the infection at birth. They develop it while nursing. For about $4 each, we can provide medicine that will keep the babies from developing the infection. Third, the money provided for prevention and education should go to the lowest level of community organization—to towns and villages rather than to national governments.

More than $1 billion has been spent on AIDS in Africa, but it has not all been spent effectively. One practical and inexpensive step would be to distribute wind-up radios in the rural areas. The radios—which don't require batteries or an electrical outlet—can be used for information programs from the Voice of America and other sources as part of a continuing effort to educate people on AIDS prevention.

Of course the perfect solution would be to develop a vaccine, but that is an expensive and a problematic operation. Any new medicine involves testing on human subjects, with some patients getting active antibodies and others a placebo.

Instead, we need to work through programs such as the International AIDS Vaccine Initiative (IAVI), which is establishing links with African nations to allow drug testing. In exchange, African countries will have the right to receive the drug at prices they can afford.

What Happens to the Kids?

Finally, we need to see AIDS in Africa not only as a disease but as a long-term social issue. During one trip to Africa about 10 years ago, I had lunch with Zambian President Kenneth Kuanda. He said, "I don't know what I am going to do when I have 500,000 orphans on the streets of Lusaka." Now they are there.

What will happen to all those kids? Who will house and educate them? Will they be able to get jobs and be productive? We must bring Africa into the world economically by fostering trade and investment. Only by allowing Africa to become economically productive, with its own public-health infrastructure, can there be any long-term approach to the AIDS epidemic.

There is no simple solution. AIDS has to be fought house to house, village to village. It can be controlled only by convincing men and women that they must be aware of the disease and act appropriately to avoid getting it.

Jim McDermott is a member of the US House of Representatives from the State of Washington.

You may help provide a better world for African children by giving to the Bishops' Appeal: Hope for the Children of Africa. Be sure to include the Advance number #101000-4, on your checks. Contributions may be made payable to your local United Methodist church and put into the collection plate, or they may be made payable to the Advance for Christ and His Church and mailed to: The Advance 475 Riverside Dr., Room 1400 New York, NY 10115

Resources for the Appeal can be ordered free by calling 1-888-862-3242.