Focus on primary health care is needed to fight AIDS

It's not glamorous, but basic medicine is key to improving health in poor areas

By Keith Martin MD, Montreal Gazette - July 21, 2010

At this week's International AIDS Conference in Vienna, many excellent solutions will be discussed about how to combat the pandemic, from treating people with antiretroviral drugs (ARVs) once they are diagnosed (Vancouver's Seek and Treat Program) to ways we can better stop the transmission of the virus from mother to fetus. We already possess the knowledge to prevent, treat, and manage this disease effectively; however, there is still a massive gap between the treatments we have and their availability for those who need them.

What good are ARVs if there isn't a health-care worker to test the patient, dispense the medications, and follow up with them? What good are ARVs if adequate diagnostics are not available? What if you don't have access to adequate nutrition? (An HIV-positive person needs 1,500 calories per day minimum, versus 1,200 calories if you are HIVnegative. Proper nutrition is the most important "drug" for a person who is HIV positive.) What if the medications needed to treat the many other diseases that can kill people, whether they have HIV or not, are not available? What are the effects on a population's health if the people do not have access to clean water with which to take their drugs? How do you dispense information on prevention, along with the condoms people need to protect themselves, without a skilled primary health-care worker?

The number of new infections still vastly exceeds the number of new patients receiving treatment, so prevention is crucial to containing the disease. There is only one proven way to confront collectively the AIDS pandemic and the other common preventable or treatable diseases that kill tens of millions of people per year: Invest in primary health care. This is the best way to implement an integrated program that enables us to manage a patient's overall health needs -from prevention to treatment. As Michel Sidibe, executive director of UNAIDS said, "AIDS isolation must end."

There is also a natural convergence between addressing the AIDS pandemic and improving maternal and child health (a commitment to the latter was just made at the G8 Summit in Ontario). Quite simply, if you can provide good obstetric care for a pregnant woman, it means there is access to basic surgical capabilities, trained health-care workers, basic medications, electrical power, access to proper nutrition, and clean water. These are the same assets needed to prevent HIV infections and treat those who are HIV positive. An enormous added benefit is that with these capabilities, 80 per cent of the problems in an emergency room can also be treated.

Annually, 50,000 women around the world die during pregnancy every year from complications associated with AIDS. Most of these deaths are entirely preventable. To save these women's lives, along with the 380,000 pregnant women and 8.8 million children who die every year from entirely preventable or treatable causes, the international community must redouble its efforts to invest in primary health care. This is not glamorous, but it works. If we strengthen this often-neglected area in health care, then we can provide maternal care, infant care, HIV programs, tuberculosis programs, and much more. Access to primary care is truly the common path that will dramatically reduce the annual death toll of so many people who die needlessly in the developing world.

The international community must stop focusing on specific diseases and instead take a broader, public health view. Vienna's AIDS conference offers an ideal opportunity to break down the silos, cast a spotlight on what works, and invest in the primary health care systems that low-income countries need to improve the overall health and welfare of their people, whether they are HIVpositive or not.

Keith Martin is a physician and a Liberal MP from British Columbia. He is the founder of the Canadian Physician Overseas program and of the Centres for International Health and Development initiative.