Jim Yong Kim, the former HIV director at the World Health Organization, asked an MIT audience to recall the time when many health experts believed the best approach to AIDS in Africa was to let people die.
"It's very hard to imagine a very few years ago, the consensus was not to treat," said Kim, who gave the Arthur Miller Lecture on Science and Ethics Oct. 23 on "Human Rights, Ethics and the Global Response to the AIDS Pandemic: Why We Can't Wait."
The talk was sponsored by the Program in Science, Technology and Society (STS) and held in Bartos Theater.
Citing reasons varying from "it's too expensive" to "Africans are too 'primitive' to deal with complex treatment," to "treatment will take attention away from prevention," many world health officials did not jump to distribute new anti-AIDS drugs in Africa during the late 1990s, Kim said.
But Kim, now director of the Francois-Xavier Bagnoud Center for Health and Human Rights at the Harvard School of Public Health, argued passionately that treating those with AIDS was a matter of human rights. The failure to treat--as well as prevent--the disease is "duplicitous and cowardly," he told his audience.
Moreover, new antiretroviral drugs could be effectively distributed and used even in developing nations, he said. To dramatize his point, he displayed slides showing before and after pictures of AIDS patient Joseph Jeune. The first photo showed an emaciated, near skeletal figure; the second, a smiling, more robust man.
Kim, who was a founding trustee of the international group Partners in Health and also a 2003 MacArthur "genius" award winner, recounted the history of the change in attitudes about AIDS to illustrate his suggestion that we "re-think the entire world of human rights" to focus on "human rights in the doing."
Certainly the AIDS situation is grim. Three million people die each year from AIDS, and 40 million people are infected, with about 80 percent of them living in the world's poorest countries, Kim said. The high infection rate in many African countries means that if the death toll is not halted, "in two generations you will face social collapse," he said.
Kim noted that many health workers who advocated against treatment were not bad people; rather the grim work and horrific situations had forced many to make tough choices and they saw hard decisions as part of the profession. "There was a kind of machismo in the public health world," he said.
Kim took another approach. At WHO, he launched a "3 by 5" program to get three million AIDS victims into treatment by 2005--"It was no longer a debate, it was a target." The target was deliberately overly ambitious; three million will probably be in treatment by 2008--"not bad" for a health organization, Kim said.
Moreover, treatment and prevention went hand in hand and setting up the infrastructure to treat AIDS almost meant creating primary care programs for all, he said. The next target is universal access to health care by 2010.
Asked by a member of the audience if his work was overwhelmingly depressing, he replied, "The only thing you have to keep telling yourself is 'My depression is not the point.' Optimism is a moral choice."
Kim pointed to worldwide efforts against smallpox and polio as examples of how health battles can be won. "In a world in which we're spending $2 billion a day for a war in Iraq that many people are questioning, why would public health officials argue against the kinds of investments which are very modest in comparison for treating a deadly condition that affects so many people?'' he said.
A version of this article appeared in MIT Tech Talk on November 1, 2006 (download PDF).
