In recognition of World Aids Day, Doctors Without Borders, or Médecins Sans Frontières, offered two premiere screenings recently of the documentary film, “AIDS Treatment: Reaching the People?” at UCLA and in Santa Monica at the Laemmle Theatre. At UCLA, the film was hosted by the UCLA AIDS Institute as part of World AIDS Day Teach-In, with a discussion following it moderated by Professor Roger Bohman.
The film documents the lives of patients and medical teams in Doctors Without Borders’s HIV/AIDS treatment programs in Malawi, Thailand and Guatemala. The film’s message is that six million people urgently need treatment for HIV/AIDS in order to survive and what it will take for HIV/AIDS medicines to reach them in time. Only 440,000 of the six million people needing antiretroviral treatment in developing countries have access to it.
Much of today’s research and treatment is targeted at developed countries where patients attend fully equipped, modern clinics. However, the vast majority of patients living with HIV/AIDS live in developing countries. The film stressed that priority must be given to research that focuses on the needs of patients in developing countries and their specific conditions.
“Research and development efforts leading to practical advances in treating the poorest communities most affected by HIV/AIDS should be prioritized as part of a comprehensive response to AIDS,” said Daniel Berman, coordinator of Doctors Without Border’s Campaign for Access to Essential Medicines.
After the screening, Doctors Without Borders’ volunteer physicians spoke to the audiences. “Doctors without Borders has succeeded in making a difference to our patients and their families, but we have not seen massive scale-up efforts in most of the countries where we work,” said Dr. Rowan Gillies, president of Doctors Without Borders, MSF International. “Everyone now agrees on the urgent need for increased access to treatment … but actual progress remains at a snail’s pace. Outside the few clinics offering antiretroviral treatment, the treatment landscape is a desert. The imperative to fund and manage treatment programs is still being neglected.”
In the last few years, much has been learned about expanding AIDS treatment through Doctors Without Borders and other treatment programs that has enabled increases in patient enrollment. First, the use of simplified treatment regimens. “Although they are not the final answer to AIDS, triple drug cocktails literally allow people to rise from their deathbeds, and live normal, longer lives,” said Dr. Arnaud Jeannin of Doctors Without Borders in Malawi. “More than 75 percent of new patients start treatment on these affordable one pill, twice-a-day formulations produced by generic companies. Clinical and biological results have been excellent with overall probability of survival at 85.3 percent after 24 months of treatment.”
Another significant factor leading to good treatment results is program design: Doctors Without Borders offers treatment free of charge, as well as providing support and education to help people take their medicines correctly and consistently. This last factor is considered essential in slowing the onset of resistance.
The number of patients treated in Doctors Without Border’s projects has increased rapidly with 150 percent more patients today than in December 2003. Overall, however, the film indicates that AIDS remains undefeated. This is due partly to the lack of pediatric formulations of antiretroviral medicines. Treating a child costs five or six times more than treating an adult. “Since companies do not make easy-to-use triple drug combinations for children, I do what most doctors are doing: I try to show caregivers such as grandparents how to crush and break adult tablets, hoping that the children will get the doses they need. Small children can’t swallow tablets, so they have to use different syrups in different quantities, which complicates treatment,” said Dr. Koen Frederix, a pediatrician who works in Malawi.
The other reason the AIDS pandemic remains unabated, doctors said, is the lack of reliable diagnostic tests to detect tuberculosis, the number one opportunistic infection in HIV-positive individuals. In some countries, up to 70 percent of people who have tuberculosis also have HIV/AIDS.
Doctors Without Borders is a nonprofit group that has been caring for people living with HIV and AIDS in developing countries since the mid-1990s. In 2000, it began offering antiretroviral treatment in its programs in Cameroon, Thailand, and South Africa. Today, Doctors Without Borders provides antiretroviral therapy to 23,000 people in 27 countries. Of these 23,000 patients, 1,400 are children.
For more information on Doctors Without Borders, go to www.doctorswithoutborders.org.