The United Nations Global AIDS Conference that recently concluded in New York City has once again thrust the issue of how to best approach the worldwide AIDS crisis – particularly in those countries hardest hit by the disease and least able to cope with its effects – into the public spotlight. The battle against HIV/AIDS that is currently being waged in sub-Saharan Africa would benefit from prudent reasoning, weighing the conflicting moral arguments over the distribution of HIV/AIDS treatment drugs in order to reach a sensible, though not utopian, solution. Such an approach is especially necessary as the debate gains momentum and as the loss of human life mounts.
The conference focused both on the formulation of an international response to the HIV/AIDS epidemic and on methods for treating the disease, particularly in the impoverished countries of sub-Saharan Africa. The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that 26.5 million of the 37 million people afflicted with the virus worldwide live in sub-Saharan Africa.
The African crisis brings to mind Christ’s words in Matthew 25:40, "Whatever you did for one of the least of these brothers of Mine, you did for Me." There is no question that we must address the problem of HIV/AIDS. And the complex issue of providing HIV/AIDS drugs should be approached compassionately and sensitively, but also with wisdom and prudence.
Christians living in a fallen world are frequently faced with difficult choices that may result in imperfect outcomes either way. The HIV/AIDS pandemic in Africa is just such a case. In these situations, prudence must direct our actions so that the greater good is maximized for the most people. It is for this reason that the current best course of action in addressing HIV/AIDS in Africa is not the free distribution of medicines but investment in morality education, drug research, and healthcare infrastructures.
Admittedly, this approach does little to address the problem right now, and there are thousands dying from the disease each day. This horrible situation presents a moral conundrum for both advocates and opponents of short-term plans such as the free distribution of treatment drugs. Those in favor of such schemes argue that it is necessary to provide HIV/AIDS drugs to the afflicted, lest we forego compassion toward the sick and needy. The South African government took this approach when it announced recently that it would begin production and distribution of generic equivalents of the current HIV/AIDS drugs, an action that violates international patents and trade agreements. This strategy is also morally troubling, however, because it so obviously disregards the rule of law, respect for which desperately needs to be encouraged in the developing economies of sub-Saharan Africa. It also undermines the profit structure of drug companies, which require some return to reinvest in research and development with the ultimate goal of finding a cure.
But since there is no cure yet for HIV/AIDS, any efforts to make HIV/AIDS treatment drugs widely available in the developing world must be tied to strong prevention efforts. The best way to stem the disease is to stop the spread of new infections. Despite the unpopularity of saying so, HIV/AIDS, with rare exceptions, is an entirely preventable disease. While there are certainly those who have contracted the disease through no culpable fault of their own (such as women who are infected by husbands who contracted the disease from another sexual partner, children who have been given the disease in the womb, or those who have become infected through blood transfusions) the majority of cases of HIV/AIDS infection can be traced to a willful, immoral act on the part of a human being. To address this aspect of the problem, the international community must encourage strong families and morality, including abstinence from sexual activity outside of marriage and faithfulness within marriage.
Some who dismiss the role of strong families in combating such a disease might suggest that justice and concern for our global neighbors, particularly those less fortunate, demand that drug companies freely distribute medicines to those unable to pay for their own treatment. But like most issues, the facts of the matter become considerably less simplistic upon further scrutiny. Many of the African countries most affected by the HIV/AIDS epidemic lack the health care infrastructure necessary (i.e., a severe shortage of medical personnel, adequate refrigeration, and dependable distribution systems) to offer effective treatment. If the pharmaceutical companies were to simply give HIV/AIDS drugs to countries with no assurance about the necessary infrastructure being put into place, the virus could quickly mutate into strains resistant to non-regular treatments, making the epidemic even worse.
The global community must ask whether it is just and prudent to risk the development of drug-resistant strains of the virus, especially given current conditions that could make drugs less likely to be effective on those who are currently suffering from HIV/AIDS. Until we can be assured that current HIV/AIDS drugs are likely to be effectively administered and that the development of drug-resistant strains of the virus is minimized, these drugs should not be freely distributed to African countries because the risks are simply too high. While this course of action yields far from perfect results in the short term, it is the best possible option among many undesirable choices, given current conditions.