In many areas of Africa, the stigma of AIDS so alienates people that many refuse to be tested. Those who are diagnosed with the virus are often ostracized, even from their own families, and left with no hope for treatment.
In the global battle against HIV and acquired immune deficiency syndrome, a $335 million federal grant will soon provide countries in Africa, as well as in the Caribbean and Latin America, with the anti-retroviral medications that have revolutionized care in the United States.
"Once people know there are meds, it could all be different," said Esther Ndiang'ui, who recently moved to the United States from Kenya, where she worked in health care. "They know meds can save their lives. Mothers will get treated because they know the meds will help their babies."
The federal Health Resources and Services Administration announced the grant last week as part of the first phase of the Bush administration's pledge to spend $15 billion in a five-year effort to fight AIDS. A Maryland-based consortium that includes Catholic Relief Services, the University of Maryland Institute of Human Virology and Interchurch Medical Assistance Inc. in New Windsor, where Ndiang'ui has worked for the past year, will share the grant.
With the drugs comes hope, said Jacqueline Patterson, infectious diseases program manager at IMA, a nonprofit association of 12 Protestant relief and development agencies. The organization's role in implementing the grant will likely be a continuation of its efforts to procure medical equipment, supplies and pharmaceuticals, and deliver them to its partners around the world, many of whom are Protestant missionaries.
"The availability of drugs will have widespread practical and social ramifications," said Patterson, a New Windsor resident. "Drugs and education can mean this is not a death sentence. The chances for transmitting the virus will lessen. AIDS could become a chronic disease as opposed to certain death."
The grant could help prevent as many as 7 million new infections worldwide and provide care and support for more than 10 million people living with the illness, health officials said.
"When the retrovirals first came out, they were so expensive they were not an option for many in Africa," said Dr. Glen Brubaker, a physician who spent more than 30 years as a missionary to Tanzania and is continuing his research for IMA in New Windsor. "Now we can offer these aggressive treatments to many people. All the resources this grant will offer to hospitals, labs, even information systems will have wide effects. And we can tell patients there is something available for them."
As assistant vice president for program audits and support at IMA, Ndiang'ui helped write the grant application for IMA. Six years of delivering home-based care in Kenya, where at one time as many as 14 percent of the population was infected with AIDS, gave her firsthand accounts of the devastation.
"I have had AIDS patients tell me that no one will even shake their hands and others whose own mothers will have nothing to do with them," she said. "It is devastating when even the person closest to you doesn't want you. In many areas, AIDS is not just a disease. It is a curse."
The lack of treatment and the stigma contributed to the spread of the disease often meant people ignored symptoms, she said. Government and churches have joined the battle, she said.
"People refuse to be tested for HIV because of the stigma and because they know there is nothing they will get in return for finding out they have the disease," said Ndiang'ui, who lives in Reisterstown. "In the past, everyone refused to talk about AIDS, and a lot went wrong."
The grant will also provide medicine to fight illnesses associated with AIDS and money for much-needed support programs, including those aimed at eliminating the stigma surrounding the illness.
Patterson, who interrupted a two-month tour in Africa to help plan the implementation of the grant, envisions training programs, research labs and referral networks across the continent. She sees testing, counseling and immediate referrals for those who need support.
"It means we can hire HIV program officers, set up new clinics and scale up the ones that are there already," Patterson said. "We will have resources to strengthen the drug delivery system into an uninterrupted supply chain. But it goes beyond the provision of drugs to nutritional and support programs."
New outreach programs might mean health workers can treat people sooner, Ndiang'ui said. She recalled times when she encountered starving and bedridden patients who were physically unable to take what medications she could offer.
"We cannot just watch whole populations die," she said. "A lot needs to be done, and we have to start somewhere."