From: rastern@sol.racsa.co.cr
Date: Sat, 17 Oct 1998 00:09:00 -0600 (CST)
Subject: Where is your anger?

                          AIDS IN THE DEVELOPING WORLD: WHERE IS YOUR ANGER?  


                                                           by Richard Stern

While thousands die of AIDS in the developing world,  their brothers and
sisters in Europe and North America are taking medication and getting
back to the business of  focusing on life instead of death.
The medications do work. I have seen dramatic evidence of that  in Costa
Rica, while working as a Psychologist in the Triangulo Rosa AIDS service
organization here.  Last year a dozen of my clients and friends died of
AIDS. This year, following the decision of the Costa Rican Supreme Court
ordering the government to provide retroviral medications to  all people in
the advanced stages of AIDS (CD4 of 350 or less,)  none of the twenty five
or so People with AIDS that I am touch with have died.

Many had multiple hospitalizations in  previous years, but this year there
have been only a few who have had brief hospitalizations.  The medications
do work, maybe not for every one, but they are working well here in Costa Rica.

We have a funny way of viewing history.  A common criticism of the world's
reaction to Hitler genocide, was  "how could people just sit back knowing
this was happening and not do more to prevent it?"  Church
authorities in Germany and other European  could have helped  thousands
of Holocaust victims to escape,  but didn't.  I am no expert on the
holocaust, but I know that fifty years later we point the finger of
complicity at people who were neither
Nazis nor Germans, but just remained passive or neutral.

I think in fifty more years,  people will be asking the same questions about
the AIDS epidemic. How was it possible that so many people with resources
and intelligence,  who knew so much about AIDS, sat passively  by and watched
their brothers and sisters die for lack of the same medications that
everyone knows
can prevent  the deaths of people with AIDS?

When the disease broke out and there were no medications, the Northern
country activists, with their tradition of skilled protest, took to the
streets and demanded better results from public as well as private
interests. They demanded the search for medications that could save their
lives.   But once they got the medications, they have become  considerably
more passive, almost complacent, seemingly forgetting their brothers and
sisters in developing countries who have no skills in protesting  and no
resources to protest with.

Thousands are dying and the actual value of the  raw material ingredients of
these pills probably  is a few dollars a month per prescription. 
Its the international economic system  and pharmaceutical  pricing
structure that brings up the costs of the medications so that the
pharmaceutical companies can recover what they say were the costs of the
investigations they had to carry out to develop the  medications,  for
People with AIDS
in wealthy countries who would be able to afford to buy them.   

So this was the Act-Up deal then. Get us our meds at prices that our
insurance carriers can afford and once we are ok, we will still be liberal
and concerned, but we won't cause too many hassles.  If AIDS activism had
begun in the developing  world, instead of in  New York and Paris,  you can
be sure that the pharmaceutical companies would have  have "discovered" much
cheaper medications.  


Arguments are made that poor countries have many medical and social problems
that need resolving: malaria, cholera, dysentery, malnutrition, and that the
resources don't exist to solve all of these terrible problems.  Its true.
But none of these
other diseases are so intimately connected to a social movement as AIDS is. 
The medications that exist for  AIDS  have the blood of so many  early
ACT-UP martyrs on their prescription labels--the Michael Callens and the
Randy Shilts who never stopped trying to
change the lives of  people with AIDS.   But  the movement seems to have
slowed down,
and People with AIDS in the developing world, who can't get the meds they
need, don't even know or
understand what Act-Up was all about.  

In the  film "The Life and Times  of Harvey Milk,"  there is a
touching and telling moment which occurs on  the night of the assassination
when one of
Harvey's closest friends screams out at the silently weeping mourners at the
San Francisco capital building "Where is your anger?"    I say the same.  I
know the problem is that the people who could be angry in New York, in
London, in Vancouver or in Stockholm, literally don't see their  African and
Latin American brothers and sisters dying needlessly of AIDS. They are just too
far away.  If they were here in Central America, where I am, or in Zaire or
India,  they would be angry and they would go back to the streets.

The only possibility for change in the desperate situation confronting
people with AIDS in poor countries would come from a renewed activism in the
developing countries to go  back to the streets, back to the "zaps" and to
develop strategies to force changes
in international economic policies and agreements that enable private
companies with life saving  medications to refuse to give the medications to
people who need them unless the people come to the office with money.  The
pills sit on the shelves in  the pharmaceutical company
warehouses waiting for someone with money to come along, and outside, the
majority of the people die and nobody uses the pills anyway. 

Where is UNAIDS in all of this? Where are the activists? What will history
say in 50 years about this incredible gap in medical attention that has
occurred, and those who stood silently by?

I cross the border into Nicaragua a hundred and twenty miles from San José
Costa Rica. I don't see any real difference. The grass is equally  green,
the road is the same Interamerican Highway that stretches from Texas all the
way to Panama.  What is a border anyway?  

Yet in Costa Rica my friends are getting their medications. But in
Nicaragua,  Sergio Navas, founder of the
AIDS group called "gente positivo" (Positive People) can't get any
medications for himself or for the people in the group who die one by one,
month after month. Incredibly, there are only 250 People Living With AIDS at
this moment in Nicaragua. How much would it cost to save the lives of all of
them? About one and  a half yards of a "Stealth Bomber." If one or more
pharmaceutical companies donated the stockpiled meds that sit in their
warehouses, they could save all the people with AIDS in Nicaragua and it
wouldn't cost them anything.   The medications are just sitting there anyway.

They won't donate these meds without pressure. The pressure has to occur
there,  up North in  the developed world.  The pressure shouldn't stop until
all People with AIDS have equal access to care and treatment. That would be
a movement  worth remembering fifty years from now.


Richard Stern, Ph.D.
Tel/Fax 506-234-2411
e-mail: rastern@sol.racsa.co.cr