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教 育 專 題 深 入 報 導
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教育專題 ◎ 國際專題:愛滋病的泛濫
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◎國際專題:愛滋病的泛濫
策劃、編譯■盧永山
1.防治愛滋,經費缺缺(UNAIDS)
根據聯合國愛滋病規劃署(UNAIDS)的最新統計(如附表),至2002年止,全球感染愛滋病的人數高達4,200萬人,其中有70%,即約3,000萬人是居住在撒哈拉以南的非洲,而在本區的感染者中,58%是女性。愛滋病的蔓延已成為非洲在新世紀的最大挑戰。
為了因應這個危機,非洲國家努力集合國家資源,並成立由國家領袖負責的跨部門防治愛滋病委員會。防治愛滋病需要龐大的經費,對窮困的非洲國家而言幾乎成為不可能的任務。雖然一些國家或國際機構已表明要捐款給聯合國的「全球對抗愛滋結核瘧疾基金會」(包括美國總統布希於今年5月簽署一項法案,同意捐款150億美元,協助非洲國家對抗愛滋病),但這些捐款僅敷所需的一半。根據世界衛生組織和聯合國愛滋病規劃署的估計,光在2005年,全世界對愛滋病的防治、治療、病人照顧,所需經費就高達105億美元,其中非洲國家就占了一半以上。
經費不足的問題也反映在非洲國家,無法長期購買防治愛滋病的抗逆轉錄酵素病毒(antiretrovirals)上。儘管抗逆轉錄酵素病毒價格已經降低,但對抗愛滋病是一條漫長的路程,非洲國家或許可在短時間內可以買到藥品,解決燃眉之急,但經年累月之後,已被外債壓得喘不過氣來的非洲國家,恐怕再也無力、無錢面對愛滋病的蔓延。
因此,解決這個問題的根本之道,如許多專家所言的,在於應讓非洲國家可以免除專利權之限制,以低價生產相關藥品(當然,要讓非洲國家免除疾病、戰爭之苦,而邁入先進國家之林,更要從改善國際經濟結構著手,總之,這仍是一條漫漫長路)。但國際大藥廠所在地的美國,卻不願在藥品專利權上讓步。美國一方面宣稱要捐款協助防治愛滋病,一方面卻不願在藥品專利權上做出讓步,可見美國念茲在茲的仍是該國的利益,而非誠心要解決問題。
By continuing to devastate Africa's economies, communities, and
development, HIV/AIDS has undoubtedly become Africa's biggest challenge.
"Sixty million Africans have been touched by AIDS in the most immediate
way. They are either living with HIV, have died of AIDS or they have lost their
parents to AIDS. But the toll of those directly affected is even higher,"
said Dr Peter Piot, Executive Director of the Joint United Nations Programme on
HIV/AIDS (UNAIDS), who was speaking during the Global Forum on Health and
Development at the African Union Summit. The Forum is the first-ever
international videoconference on AIDS, TB and malaria to be held at the Summit,
bringing together African heads of state, UN officials, and AIDS experts and
academics from around the world.
As the impact of AIDS continues to threaten African society, African
leaders are mounting a full-scale response to fight HIV/AIDS, targeting all
sectors. "Involving people living with HIV in the AIDS response, as well
as the broadest possible coalition in society, is the only way to succeed in
effectively turning back the epidemic," said Dr Piot. "Nineteen
African nations have established government-wide AIDS councils or commissions
personally chaired by the head of state, head of government or their deputy, to
take charge of a multisectoral response to AIDS".
Full-scale responses to the epidemic also need full scale resources.
There have been recent increases in global AIDS funding by a wide range of
international donors, including the US, UK, the World Bank's Multi-Country AIDS
Programme of grants to Africa, the Global Fund to fight HIV/AIDS, TB and
Malaria, the Gates Foundation as well as governments in affected countries. But
still the funding is only half of what is needed by 2005. According to WHO and
UNAIDS estimates, over $US10.5 billion a year will be needed in 2005 for
prevention, treatment, care and support programmes in low- and middle-income
countries. About half of that total is needed in Africa alone.
With up to 1,000 adults and children dying of AIDS each day in some the
worst-affected countries in Africa, Africa is losing a significant portion of
its young people and productive workforce. "Only if AIDS is rapidly
brought under control will social and economic development be able to
flourish," said Dr Piot. "This can become a reality if African
leaders make it their business to invest in both AIDS prevention and care and
treatment." Today, fewer than one in five people at risk of HIV infection
in Africa are targeted by an HIV prevention programme.
In addition to scaling up AIDS prevention programmes, ensuring wider
access to care and treatment for people living with HIV/AIDS must also be a
priority for African leaders. "The price at which antiretrovirals are available
to developing countries has dropped significantly, but technical facilities and
sustainable financing are still major barriers," said Dr Piot.
"African governments must seize the opportunity to expand access to HIV
care and treatment in their countries." In sub-Saharan Africa, only some
50,000 people have access to antiretrovirals (抗逆轉錄酵素病毒) out of an estimated 4
million people in need of the medicines.
Of the 42 million adults and children living with HIV/AIDS worldwide,
an estimated 30 million, or 70%, live in sub-Saharan Africa. In 2002, 58% of
those infected in the region were women.
(附表)
2002年,全球愛滋病感染和死亡人數統計(資料來源/聯合國愛滋病規劃署)
Number of people living with HIV/AIDS
Total:42 million
Adults:38.6 million
Women:19.2 million
Children under 15 years:3.2 million
People newly infected with HIV in 2002
Total:5 million
Adults:4.2 million
Women:2 million
Children under 15 years:800,000
AIDS deaths in 2002
Total:3.1 million
Adults:2.5 million
Women:1.2 million
Children under 15 years:610,000
2.對抗愛滋,光吃藥還不夠(Reuters)
全世界有70%的愛滋病感染者居住在非洲撒哈拉以南國家,為了防止疫情擴大,非洲國家向國外購買了抗逆轉錄酵素病毒。不過,1983年發現HIV病毒的人類病毒學家羅伯.蓋洛,在巴黎舉行的國際愛滋協會大會上指出,非洲國家急欲抑止愛滋病的心情可想而知,但防治愛滋病除了要病人服藥之外,還需考量其他配套措施,例如,建立醫療照顧體系。羅伯.蓋洛認為,愛滋病患光服藥還不夠,還需要細心的照料和檢測,而且病患一旦服完藥,可能導致病毒的抗藥性,這非得建立基礎的醫療照顧體系來加以解決不可。對窮困的非洲國家而言,建立基礎醫療照顧體系,的確不是件容易的工作。
Two decades into the global AIDS pandemic, governments around the world
are finally talking of committing tens of billions of dollars to fight the
killer disease in developing countries.
But Robert Gallo, the scientist who co-discovered HIV in 1983, warned
on Monday there were serious dangers from embarking on widespread treatment in
sub-Saharan Africa without adequate medical infrastructure.
"Obviously it is critical to get available drugs to developing
nations as quickly as possible, but not just to throw this at them,"
Gallo, director of the U.S.-based Institute of Human Virology, told Reuters.
"We've got to have infrastructure created at the same time because
we are going to create multi-drug resistant mutants if we don't."
Gallo said AIDS patients needed extensive medical care, including
testing and monitoring to ensure compliance with drug regimens, something that
may simply be impractical in parts of Africa where many do not have basic
healthcare.
The issue of how to get drugs to the vast majority of the world's 42
million HIV infected people is dominating discussions at the International AIDS
Society conference in Paris, where Gallo was speaking.
Activists say six million face imminent death without access to
affordable drugs and have urged governments to pledge more to the Global Fund
to Fight AIDS, Tuberculosis and Malaria in order to speed up treatment in
Africa, the center of the pandemic.
President Bush in May signed into a law pledging $15 billion to help combat
the deadly disease, trebling(3倍) U.S. spending over five years and sparking
calls for other industrialized countries to dig deeper in their pockets.
Gallo, however, is something of a dissenting voice in the chorus of
support for widespread treatment by highlighting the risk that powerful
antiretrovirals, if not taken correctly, can quickly induce virus resistance.
"Nobody talks about that...the danger of failure is very real in a
few years if the drugs are just dumped there," Gallo said.
"There'll be great happiness with the drugs being made available,
as I would see the future, for two to five years and then we're going to start
seeing problems if it is not done right."
Other speakers at the conference acknowledged the need for
on-the-ground medical expertise but argued the risk of resistance should not
deter the build-up of large treatment programs.